Health Library

Treatment for Your Child’s Atrial Septal Defect (ASD)

Your child has an atrial septal defect (ASD). This is a hole in the dividing wall (atrial septum) between the two upper chambers (atria) of the heart. Your child’s cardiologist has determined that the ASD won’t close on its own and has suggested repair. ASD repair can be done in one of two ways: with cardiac catheterization or with heart surgery. Your child’s cardiologist or surgeon will discuss the best treatment for your child with you.

Your Child’s Experience: Cardiac Catheterization

Cardiac catheterization is a procedure done on the heart using a thin, flexible tube called a catheter. It’s performed by a cardiologist who has special training to use catheters to treat heart problems (cardiac catheterization). The procedure lasts about 2–4 hours. It takes place in a catheterization laboratory. You’ll stay in the waiting room during the procedure.

• Before the procedure: You’ll be told to keep your child from eating or drinking anything for a certain amount of time before the procedure. Follow these instructions carefully.

• During the procedure: Your child is given medication (sedative or anesthesia). This is to help him or her relax and not feel discomfort or pain during the procedure. A breathing tube may be placed in your child’s trachea (windpipe). Special equipment monitors your child’s heart rate, blood pressure, and oxygen levels. The catheter insertion site (the groin) is cleaned and numbed. Then the catheter is inserted into a blood vessel in the groin. With the help of live x-rays, the catheter is advanced up through this blood vessel into the heart. Contrast dye may be injected through the catheter. The dye allows the inside of the heart to be seen more clearly on x-rays. A closing device is used to close the ASD. It’s delivered by the catheter and placed in the ASD. Then the catheter is removed.

• After the procedure: Your child is taken to a recovery room. You can stay with your child during much of this time. It may take 1–4 hours for medications to wear off. Pressure is applied to the catheter insertion site to limit bleeding. The leg with the catheter insertion site may need to be kept still for about 2–4 hours. Your child is cared for and monitored until he or she can leave the hospital. An overnight hospital stay is usually required.

Risks and Possible Complications of Cardiac Catheterization Include:

• Reaction to contrast dye

• Reaction to sedative or anesthesia

• Pain, swelling, redness, bleeding, or drainage at the catheter insertion site

• Incomplete closure of the ASD, requiring further treatment

• Arrhythmia (abnormal heart rhythm)

• Injury to the heart or a blood vessel

Your Child’s Experience: Heart Surgery

Heart surgery to repair an ASD is performed by a pediatric heart surgeon. The surgery lasts about 2–3 hours. It takes place in an operating room in a hospital. You’ll stay in the waiting room during your child’s surgery.

• Before surgery: You’ll be told to keep your child from eating or drinking anything for a certain amount of time before surgery. Follow these instructions carefully.

• During surgery: Your child is given medication (sedative and anesthesia) to sleep and not feel pain during surgery. A breathing tube is placed in your child’s trachea (windpipe). Special equipment monitors your child’s heart rate, blood pressure, and oxygen levels. Your child is also placed on a heart-lung bypass machine. This allows blood to continue flowing to the body while the heart is stopped so that it can be operated on. An incision is made in the chest through the sternum (breastbone) to access the heart. The ASD is repaired with either stitches or a patch. Then your child is taken off the bypass machine and the chest is closed.

• After surgery: Your child is taken to a critical care unit to be cared for and monitored. You can stay with your child during much of this time. He or she may remain in the hospital for 3–5 days. When your child is ready to leave the hospital, you’ll be given instructions for home care and follow-up.

Risks and Possible Complications of Heart Surgery Include:

• Reaction to sedative or anesthesia

• Incomplete closure of the ASD, requiring further treatment

• Arrhythmia (abnormal heart rhythm)

• Lung problems

• Infection

• Bleeding

• Nervous system problems

• Abnormal buildup of fluid around the heart and lungs

When to Call the Doctor

After the cardiac catheterization procedure or heart surgery, call the doctor right away if your child has:

• Increased pain, swelling, redness, bleeding, or drainage of an incision or insertion site

• A fever:

  • In an infant under 3 months old, a rectal temperature of 100.4°F (38.0°C) or higher

  • In a child 3 to 36 months, a rectal temperature of 102°F (39.0°C) or higher

  • In a child of any age who has a temperature of 103°F (39.4°C) or higher

  • A fever that lasts more than 24-hours in a child under 2 years old, or for 3 days in a child 2 years or older

  • A seizure caused by the fever

• Chest pain

• Increased tiredness

• Trouble breathing

• Nausea or vomiting

• A cough that won’t go away

• An irregular heartbeat