Secundum atrial septal defect

Provided by "Pediatric Heart Surgery — a reference for professionals"

Pathophysiology

Atrial septal defect is a common congenital heart defect that results in left-to-right shunting of blood. The amount of blood shunting across a secundum atrial septal defect depends on the size of the defect and the relative compliances of the left and right ventricles during diastole. Left-to-right shunting of blood results in excessive blood flow to the right ventricle and pulmonary artery. Right ventricular and right atrial dilatation results. With prolonged dilatation, right ventricular dysfunction and atrial arrhythmias can occur. In addition, long standing pulmonary overcirculation can eventually lead to pulmonary vascular obstructive disease.

Surgical technique

Closure of secundum atrial septal defect can, in some cases, be accomplished by the interventional cardiology team using a catheter-based approach. A device is deployed to close the defect. Careful patient selection is required to use this approach, as certain defects are more amenable to device closure than others. Surgery to repair atrial septal defect requires cardiopulmonary bypass and aortic cross-clamping. The right atrium is opened, the defect is visualized, and it is closed using a synthetic patch or autologous pericardium. Smaller defects can be closed primarily. Aortic cross-clamp time and cardiopulmonary bypass time required to complete repair are short. Patients who undergo this operation should be extubated early in the postoperative course.

Postoperative considerations

The postoperative course following ASD closure is usually benign. Invasive monitors used include arterial and central venous catheters. Intracardiac monitoring catheters and vasoactive infusions are rarely required for hemodynamic management. Length of hospital stay required following surgery averages 4 to 6 days.