ASD/VSD Closure Repair: Causes, Symptoms and Recovery

Atrial Septal Defect is a congenital heart defect in which there is a hole in the wall (septum) between the upper chambers of the heart (atria). This hole allows blood to flow between the atria, which leads to increased blood flow to the lungs. While small ASDs may not cause any significant concerns, whereas larger ones may require medical attention, such as surgical repair, to prevent complications.

The main reason for atrial septal defects remains elusive, manifesting as an alteration in the heart's structure during fetal development. The intricate process of the baby's heart formation is an essential stage for the emergence of this condition.

ASDs may arise due to the following factors, including

Genetic variations
Specific medical conditions
Exposure to particular medications
Smoking

Atrial septal defects (ASDs) may be better understood by considering the normal functioning of the heart, which has four chambers – two atria and two ventricles. The right side of the heart directs blood to the lungs for oxygenation, while the left side pumps oxygenated blood throughout the body via the aorta. A significant ASD can lead to an excess flow of blood to the lungs, straining the right side of the heart. If left untreated, this can result in the enlargement and weakening of the right heart chamber and an elevation in pulmonary artery pressure, Causing pulmonary hypertension.

There are different types of ASDs classified based on the Location and the size of the hole, these include:

Scendeum Atrial Defects: It is the most common type of ASD, in which a hole occurs in the central part of the atrial septa (wall of the heart).
Primum Atrial Septal Defects: It affects the atrial septum's lower part which is closer to the Tricuspid valve.
Sinus venous Atrial Septal Defect: This defect occurs closure to the Superior Vena cava or inferior vena cava.
Coronary Sinus Atrial Septal Defects: This is the least common type of ASD in which the defect is associated with Coronary Sinus.

A new baby born with an atrial septal defect (ASD) may remain unknown and have no symptoms for many years, it may appear in the later stage of life. Symptoms of an atrial septal defect may include:

Shortness of breath, particularly when exercising
Fatigue, especially with activity
Swelling of the legs, feet, or belly area
Arrhythmias(Irregular heartbeats)
Palpitations(fluttering heartbeat, skipped heartbeats or feelings of a quick, pounding)

The diagnosis of ASDs may involve a combination of Clinical assessments, The common methods. These diagnostic tests are recommended by the doctor:

Chest X-ray: It is performed to visually represent the size and shape of a heart and the Lungs.
Echo(Echocardiogram): It is the major test used to visualize the structure and function of the heart.
Electrocardiogram (ECG or EKG): This helps in the identification of irregularities in the heart’s rhythm or conduction.
Catheterization: In some instances, cardiac catheterization involves a thin tube inserted into the blood vessel.
MRI (Magnetic Resonance Imaging) and CT scan: They help to provide 3-D images of the heart and surrounding structures.

Atrial septal defect (ASD) repair is used to close a hole in the septum, There are different methods for repairing ASD, and the choice of procedure depends on the size, the position of the defect, and the patient's general health the determining factors in choosing the appropriate treatment.

Here are the common ways of treatment:

Medication: Generally Medicines won’t close the holes in the heart but they reduce the symptoms. Medicine advised are beta Blockers, Anticoagulants, and Diuretics.
Surgeries: Surgeries are performed to repair the atria ventricular defects in the heart. Two different types of surgeries can be performed to close the hole in the heart:
- Open Heart Surgery: It is the primary procedure used to close holes in the heart. It is performed by making a chest incision and opening the chest with surgical instruments to access the heart. After that, the heart is placed on bypass, which entails attaching it to a device that circulates blood throughout the procedure. It is also referred to as the heart-lung bypass machine for the same reason. The surgeon subsequently closes the incision using sutures or applying a biological patch that fuses with the surrounding muscle. Once the hole is repaired, the chest is closed and the incision site is closed with sutures.
- Catheter-based repair: This type of ASD repair surgery is minimally invasive surgery it involves a catheter threaded through the blood vessels from the groin to the heart. to get to the heart. A closure device made of mesh-like material or a combination of fabric or metal is guided through the catheter to the exact location.
- Robotic-Assisted Surgery: This method is also called minimally invasive surgery. The repair is performed by using a robot, it's called robot-assisted heart surgery.

Post-surgery, patients usually have a short hospital stay, with transcatheter closure requiring 1-2 days and open-heart surgery lasting 3-7 days, sometimes involving ICU transfer to continue monitoring. A comprehensive recovery plan involves regular follow-up appointments, dietary adjustments, wound care, and emotional support. Additionally, effective pain management, adherence to activity restrictions, and a gradual return to normal activities are crucial components of the recovery process.