Procedure for ASD Closure in Adults

Congenital Heart Defects

Two common types of congenital heart defects in the heart are:

• Atrial septal defect (ASD)
• Patent foramen ovale (PFO)

In both these congenital heart diseases, there are holes in the wall/septum between the upper left and right heart chambers called atria. Both these conditions have different causes. ASD is considered a congenital heart defect (defect present at birth).

The foramen ovale is a hole in the septum between the left and right atria of the foetus. This facilitates circulation of oxygen rich blood in the lungs of the foetus. At birth, when the newly born infant breathes for the first time, the foramen ovale usually closes within a few months. When this does not close by itself, it is called a patent (in this context it means open) foramen ovale. .

Atrial Septal Defect Symptoms

The atrial septal defect symptoms commonly seen in adults and which need immediate medical help are:

• Breathlessness/Shortness of breath during exercise
• Tiredness/Fatigue
• Swelling on legs/feet/abdomen
• Heart palpitations
• Skipped heart beats
• Frequent lung infections
• Stroke
• Heart murmur (a "swishing" heart sound heard with a stethoscope)

ASD Treatment

Usually the atrial septal defects close on their own in childhood. The following are some of the treatment options in this case:

Medications: cannot repair this congenital defect, however, they are used to control the atrial septal defect symptoms. Medicines can also lower the risk of complications post-surgery. Some of the medicines used are:

• Betablockers: used for regulating the heartbeat
• Anticoagulants: used for reducing the risk of blood clotting

Heart Surgery

Surgery is usually recommended for repairing medium/large-sized ASDs. However, in case of severe pulmonary hypertension, surgery is not advised. The common surgical interventions used are:

Cardiac catheterization: in this surgery, a thin tube called as catheter is inserted into a blood vessel and guided to the heart with the help of imaging. Through the same catheter, a mesh/patch/plug is placed and the hole is closed. Consequently, the heart tissue grows around this mesh, by which the hole is permanently sealed.

Open Heart Surgery: Some large atrial septal defects (also known as secundum atrial septal defects) cannot be repaired through cardiac catheterization such large ASDs might require an open-heart surgery. The open heart surgery is usually done under general anesthesia and needs the ventilator (heart-lung machine). Through an incision in the chest, patches are used to secure the defect/hole. This surgery is the choice of treatment especially in atrial septal defects like coronary sinus, primum or sinus venosus.

Follow up: Adults who have undergone atrial septal defect repair need to go for regular follow-ups for monitoring complications like:

• Heart failure
• Arrhythmias
• Valve conditions
• Pulmonary hypertension

Post Discharge Lifestyle

Some things to take care of after an ASD repair are:

1. Healthy Diet

   The diet should be heart-healthy and should be low in saturated fats, sodium and cholesterol. It should include fruits, vegetables, omega fatty acids and whole grains.

2. Stay physically active

   ASD should not refrain one from exercising. However, in case of complications like heart failure, arrhythmias or pulmonary hypertension it is better to consult the cardiologist for advising on what physical exercises one can do.

3. Preventing inherent infections

   Some heart defects and their repair might cause changes on the heart tissue surface. This surface can be susceptible for a bacterial infection (as in the condition of infective endocarditis). Hence taking necessary preventive measures is the best way to tackle the infections.