Atrial Septal Defect Repair In Children—Transcatheter Procedure
Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Child’s Doctor If Any of the Following Occurs
An atrial septal defect is a hole in the wall between the two upper chambers (right and left atriums) of the heart. A transcatheter procedure is a minimally-invasive way to repair the hole. During this procedure, a device is implanted to seal the hole. As your child recovers, the device will trigger the heart tissue to grow. The tissue will slowly grow over the hole.
Reasons for Procedure
If a child is born with a hole between the upper chambers of the heart, the blood can flow backward into the right side of the heart and into the lungs. This triggers the heart to work harder. Over time, this can lead to damage to blood vessels in the lungs and congestive heart failure. The procedure is done to fix the hole.
Blood Flow Through the Heart
Most children who have this procedure will have good outcomes.
Complications are rare, but no procedure is free of risk. Possible complications may include:
- Bleeding at the point of the catheter insertion
- Damage to arteries
- Allergic reaction to x-ray dye
- Blood clot formation
- Infection, including endocarditis (infection of the inner lining of the heart muscle)
- Reaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing)
- Blood clot formation
- Arrhythmia (abnormal heart beat)
Some factors that may increase the risk of complications include:
- Pre-existing conditions (eg, bleeding disorder, kidney problems)
- Recent infection
Discuss these risks with the doctor before the surgery.
What to Expect
Prior to Procedure
The doctor will do a physical exam of your child. Tests may include:
- Blood and urine tests
- Echocardiogram —a test that uses sound waves to visualize functioning of the heart
- Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
- Chest x-ray —a test that uses radiation to take a picture of structures inside the chest
The doctor will tell you if you child needs to stop taking certain medicine. Ask the doctor when your child should stop eating or drinking before the surgery.
General anesthesia will be used. It will block any pain and keep your child asleep through the surgery. It is given through an IV in the hand or arm.
Description of the Procedure
Your child will receive IV fluid and medicines through a vein in his arm. The catheter (small tube) will be inserted either in the arm or groin. Next, electrodes will be placed on the chest. These electrodes will send information to the EKG machine, allowing the doctor to monitor the heart.
A catheter will be inserted in the blood vessel and advanced so the end is in the heart. Dye will be injected to allow the doctor to view x-ray images of the heart. An echocardiogram may also be used. Before the hole can be covered, the doctor will need to find out the size of the hole. A catheter with a balloon attached to it will be sent to the upper chambers of the heart. The balloon will inflate and measure the hole.
Once the doctor knows the size of the defect, another catheter will be sent to the heart. This catheter will have a device attached. There are different types of devices available. Some are able to open so that the hole is covered on both sides. Other devices open like an umbrella to cover the defect. Once the device is placed, the doctor will remove the catheter. Lastly, a bandage will be placed over the insertion site.
Immediately After Procedure
Your child will be closely monitored in the intensive care unit (ICU). The hospital staff will:
- Place pressure on the insertion site and apply a pressure bandage
- Have your child lie flat
Average Hospital Stay
The usual length of stay is 2-4 days. In some cases, your child may be able to go home as soon as the next day. The doctor may choose to keep your child longer if there are complications.
At the Hospital
When your child is recovering at the hospital, the hospital staff may:
- Do tests (eg, EKG, chest x-ray, blood tests).
- Have your child lie still and flat for several hours. This is to prevent bleeding.
- Place a pressure bandage to reduce bleeding.
- Encourage your child to drink plenty of fluids to flush the dye from his body.
- Give pain medicine to ease discomfort.
When your child returns home, do the following:
- If directed by the doctor, give antibiotics. This will help to prevent infections in the heart.
- Give pain medicine as needed. You can also apply an ice pack to the insertion site to ease discomfort.
- Your child may be at risk for blood clots. If directed by the doctor, give medicine to prevent blood clots.
- Have your child return to his normal diet. He may need to drink plenty of fluids to flush the dye from his system.
- Encourage your child to rest. Have him avoid strenuous activities. He will slowly return to his normal routine.
- Follow all of the doctor’s instructions.
Call Your Child’s Doctor If Any of the Following Occurs
After your child leaves the hospital, call the doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Increased sweating
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the catheter insertion site
- Nausea and/or vomiting
- Dizziness, lightheadedness
- Increased pain
- Loss of appetite or poor feeding
- Not drinking enough fluids
- Not urinating
Call for Medical Help Right Away If Any of the Following Occurs
Call for medical help or go to the emergency room right away if any of the following occurs in your child:
- Fast breathing or trouble breathing
- Blue or gray skin color
- Not waking up or not interacting
- Chest pain
- Heart palpitations
- Weakness or fainting
- Signs of a stroke (eg, drooping facial muscles, changes in vision or speech, difficulty walking)
In case of an emergency, call for medical help right away.
American Heart Association
National Library of Medicine
Heart and Stroke Foundation
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Last reviewed June 2012 by David N. Smith, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.