Atrial Septal Defect Repair in Children

Medically reviewed by Drugs.com. Last updated on Jul 7, 2024.

• Care notes
• Ambulatory
• Discharge
• Español

AMBULATORY CARE:

What you need to know about an atrial septal defect (ASD) repair:

An ASD repair is surgery to close a hole in the septum (wall) between the upper chambers of your child's heart. The upper chambers are called the right atrium and the left atrium. An ASD repair is done through open heart surgery or a percutaneous (through the skin) procedure. The type of repair used depends on the size of the ASD and your child's age and symptoms.

Prepare your child for an ASD repair:

• Your child's provider will talk to you about how to prepare. Ask when and how to talk to your child about the surgery or procedure. If your child is old enough, talk to him or her and let him or her know what to expect. Explain that healthcare providers will make sure he or she is comfortable.
• Ask if there is information that explains anesthesia and the surgery to you and your child in more detail. Information given in a video or books may be available. Your child's provider may be able to take you and your child on a tour of the surgery or procedure room. Let your child pick a favorite blanket, stuffed animal, or toy to take with him or her to the hospital.
• Your child may need blood tests, a chest x-ray, an EKG, or an echocardiogram. The tests will help your child's provider plan for the repair. Your child may be able to donate his or her own blood. You, a family member, or a friend with the same blood type as your child may be able to donate blood for him or her.
• Your child's provider may tell you not to give your child anything to eat or drink after midnight before the procedure or surgery. The provider will tell you which medicines to give or not give your child. Your child will be given an antibiotic through his or her IV before the surgery or procedure. This will help prevent a bacterial infection. Tell the provider about any allergies your child has, including to antibiotics or anesthesia.
• Your child may need to take blood thinners if he or she having a procedure instead of surgery. Your child may start this medicine a few days before the procedure. Your child may instead be given a blood thinner through his or her IV on the day of the procedure. This will help prevent blood clots.

What will happen during a surgical ASD repair:

• Your child will be given general anesthesia to keep him or her asleep and free from pain during surgery. An IV may be placed in your child's wrist to monitor his or her blood pressure. A second IV may be placed in a large vein to monitor pressures in his or her heart. Your child's surgeon will make an incision in your child's chest. The surgeon will cut or spread your child's ribcage apart to reach his or her heart. Your child's heart may be connected to a bypass machine. This machine will pump blood to his or her body and keep blood out of his or her heart during surgery.
• Your child's surgeon will make an incision in your child's heart. The surgeon will close the ASD with stitches or a patch. The bypass machine will be stopped and blood will flow through your child's heart again. The incision in your child's heart will be closed with stitches. The surgeon may place a drain in your child's chest to remove air, blood, or fluid. The incision in your child's chest will be closed with stitches. A bandage will be placed over the incision.

What will happen during an ASD repair procedure:

• Your child may be given general anesthesia to keep him or her asleep and free from pain during the procedure. Your child may instead be given medicine to help him or her relax during the procedure. Your child will be awake with this medicine but should not feel pain during the procedure.
• Your child's provider will insert a catheter into a vein in your child's groin. The provider may use x-ray pictures to help guide the catheter to your child's heart. The provider will also use an echocardiogram to look at your child's heart during the procedure. The provider will insert a closure device into the ASD with the catheter. The provider will check to make sure the device is placed correctly and the ASD is closed. The provider will then remove the catheter and place a bandage over the incision.

What to expect after an ASD repair:

• Healthcare providers will monitor your child's blood pressure, heartbeat, oxygen levels, and breathing. They will check your child's bandage for bleeding or swelling. Do not let your child get out of bed until healthcare providers say it is okay. Your child may need blood tests, chest x-rays, an EKG, or an echocardiogram before he or she leaves the hospital. These tests will make sure the ASD is closed and your child's heart is working correctly.
• Your child may need to stay in the hospital for a few days after surgery. Your child may spend the first 1 to 2 nights in the intensive care unit (ICU). He or she may have several drains and IVs, and be on a ventilator. A ventilator is a machine that gives your child oxygen and breathes for him or her. An endotracheal (ET) tube is put into his or her mouth or nose and attached to the ventilator. The ET tube may be removed when your child is awake and breathing well. Your child may need a blood transfusion to replace blood lost during surgery.

Risks of an ASD repair:

Your child may bleed more than expected or get an infection. Your child may get a blood clot in his or her leg, arm, heart, lungs, or brain. Fluid may build up around your child's heart or lungs and make it hard for him or her to breathe. Your child's heart muscle or valves may be damaged during surgery. Your child may have an irregular heartbeat or develop heart failure. The devices used to close the ASD may move out of place. Your child may need another surgery or procedure to fix this.

Call your local emergency number (911 in the US) if:

• Your child has severe chest pain.
• Your child has trouble breathing or sudden shortness of breath.
• Your child coughs up blood.
• Your child loses consciousness or stops breathing.
• Your child has any of the following signs of a stroke:
  • Part of his or her face droops or is numb
  • Weakness in an arm or leg
  • Confusion or trouble speaking
  • Dizziness, a severe headache, or vision loss

Seek care immediately if:

• Blood soaks through your child's bandage.
• Your child's stitches come apart.
• Your child's heart is beating faster or slower than usual.
• Your child's mouth, lips, or tongue is blue.
• Your child is restless or anxious.
• Your child has swelling in his or her legs or feet.
• Your child has severe abdominal pain or his or her abdomen is larger than usual.
• Your child stops urinating or urinates less than usual.

Call your child's cardiologist or surgeon if:

• Your child has a fever or chills.
• Your child's pain does not get better after he or she takes pain medicine.
• Your child's appetite is poor.
• Your child gets tired easily when he or she is eating.
• Your child's incision site is red or swollen.
• Your child has nausea or is vomiting.
• Your child's skin is itchy, swollen, or he or she has a rash.
• Your child does not gain weight, or he or she loses weight.
• You have questions or concerns about your child's condition or care.

Medicines:

Your child may need any of the following:

• Heart medicine may be given to control your child's heartbeat or strengthen his or her heart.
• Diuretics may be given to remove extra fluid from your child's body.
• Antibiotics may be given to prevent a bacterial infection.
• Blood thinners help prevent blood clots. Blood thinners may be given before, during, and after your child's surgery or procedure. Blood thinners make it more likely for your child to bleed or bruise.
• Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to give your child and how often to give it. Follow directions. Read the labels of all other medicines your child uses to see if they also contain acetaminophen, or ask your child's doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly.
• NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him or her. Always read the medicine label and follow directions. Do not give these medicines to children younger than 6 months without direction from a healthcare provider.
• Do not give aspirin to children younger than 18 years. Your child could develop Reye syndrome if he or she has the flu or a fever and takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin or salicylates.

Care for your child's incision site as directed:

• Ask your child's healthcare provider when you can remove your child's bandage and bathe him or her. Your child may only be able to take a sponge bath or shower. A bath may increase your child's risk for an incision site infection. Carefully wash around the incision site with soap and water. It is okay to let soap and water gently run over the incision site. Do not scrub your child's incision site. Gently pat the site dry.
• Change your child's bandages when they get wet or dirty. Do not put powders or lotions on your child's incision site unless his or her healthcare provider says it is okay. Do not let your child swim until his or her healthcare provider says it is okay. This will decrease your child's risk for a wound infection. Check your child's incision site every day for signs of infection, such as redness or swelling.

Prevent infection:

• Wash your hands and your child's hands often. Use a germ-killing hand gel if soap and water are not available.
• Keep your child away from people who are sick. Ask family or friends not to visit if they are sick. Ask all visitors to wash their hands. Do not take your child to crowded places such as the mall or movies. Ask your child's healthcare provider how long you need to follow these directions.
• Ask your child's healthcare provider if he or she needs antibiotics before procedures. Some procedures can cause bacteria to get into your child's blood. The bacteria can travel to his or her heart and damage it. Your child may need antibiotics before certain procedures that happen in the next 6 months to prevent this. This may also include certain dental procedures. Ask your child's healthcare provider for more information.
• Ask your child's healthcare provider about vaccines. Your child may need to wait 2 to 3 months before he or she can get vaccines. Your child should continue with his or her vaccine schedule after this. Your child should get a flu vaccine every year.

Help care for your child:

• Limit your child's activity as directed. Do not let your child lift anything heavy or play sports. These actions can put stress on his or her incision and cause it to come apart. Ask your child's healthcare provider which activities are safe for your child to do. Also ask when your child can return to his or her normal activities and to school or daycare.
• Handle your child carefully. Do not pick your child up by his or her arms. This may place too much stress on his or her incision and cause pain. Place pillows behind your child's back and head when you hold or feed him or her.
• Have your child drink liquids as directed. Ask how much liquid your child should drink each day and which liquids are best for him or her. If your child still breastfeeds, ask how much he or she should feed each day. You may need to feed your child smaller amounts more often until he or she is stronger.
• Feed your older child heart healthy foods. Examples include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Ask if your child needs to be on a special diet. You may need to limit the amount of salt your child has each day. Too much salt may cause fluid to build up in his or her body and put stress on his or her heart.

Follow up with your child's cardiologist or surgeon as directed:

Your child will need to return for tests. These tests will make sure his or her heart is working correctly. Write down your questions so you remember to ask them during your visits.

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