ASD (Atrial Septal Defect)

ASD stands for atrial septal defect. It is a very common condition in which there is a hole between the two chambers of the heart known as the atria. In the normal heart, there are no holes or connections between the two atria. If an ASD is present, blood is able to freely flow through the hole from one atria to another. This bypasses the normal way blood is supposed to flow through the normal heart and over time (years), the heart becomes enlarged and the patient develops heart failure. Heart failure means that the heart is working too hard and becoming enlarged and sick.

Before the modern era of surgery, patients with ASD would develop heart failure, become very sick and die in their teens or early adulthood.  Thankfully, surgery for ASD has become a very successful and low-risk procedure that can be accomplished in patients of all ages and sizes. Today, many ASDs are able to be closed without even making an incision. This is called a catheter closure and does not require surgery. Some patients, however, because of the type, size and location of the ASD still require an incision for a safe closure and thus require the classic “surgical” approach.

Surgery

Although incisions (i.e., the classic “surgical” approach) are utilized less frequently overall these days, ASD is also present in many other more complicated congenital heart defects, and it is important that pediatric heart surgeons remain well-accustomed to closing all types of ASD. For patch material, we prefer to use something called pericardium (the tough lining around the heart) or Gore-Tex (the same durable material that rain jackets are made from). Both are time-tested materials which produce no problems for the child as they grow, even years later. Surgery for ASD requires cardiopulmonary bypass.

At Rady Children’s Hospital-San Diego, patients have been undergoing successful ASD closure surgery for more than 30 years using a standard, time-honored approach of patch closure. From 2009 to 2013 alone, 27 consecutive ASD surgical closures were performed as isolated procedures (meaning the ASD was the major thing done) with a 100 percent success and survival rate. During this same time period, many more ASDs have been successfully closed as part of more complicated operations with similar success (see tetralogy of Fallot, AV canal and TGA for examples). This is important, as it means that our surgeons have accumulated vast experience with all forms of ASD closure despite the surgery being less common than it once was.