Atrial Septal Defect Surgery: Procedures and Options

Atrial Septal Defect (ASD) repair involves two primary approaches: interventional closure performed by a cardiologist and open-heart surgical repair. The interventional method is typically recommended for patients with a central or secundum type ASD. This minimally invasive technique involves threading a thin catheter through blood vessels to the heart, where a closure device is deployed to seal the defect. This procedure is highly effective and often results in a full recovery without the need for major surgery.

Interventional Closure: A Minimally Invasive Option

Interventional ASD closure is preferred for patients who meet specific anatomical criteria. Under sedation or general anesthesia, a catheter is inserted—usually through the femoral vein in the groin—and guided to the heart. Once in position, the closure device is expanded to cover the hole in the atrial septum. This approach avoids chest incisions, reduces recovery time, and lowers the risk of infection and scarring.

Open-Heart Surgical Repair: When Surgery Is Necessary

If the patient is not a candidate for catheter-based closure or prefers surgical intervention, open-heart surgery may be performed. There are two main surgical techniques: the axillary (underarm) approach and the median sternotomy (breastbone) incision. Both procedures require the use of a heart-lung bypass machine to support circulation while the surgeon repairs the defect directly.

Axillary Incision: A Less Invasive Surgical Method

The axillary approach offers a smaller, less visible scar and is considered a minimally invasive option. However, it requires a high level of surgical expertise and is usually performed in specialized cardiac centers. During the procedure, the surgeon makes a small incision under the armpit, accesses the heart through the right side of the chest, and uses cardiopulmonary bypass to repair the septal defect.

Sternotomy: Traditional and Widely Used

The median sternotomy is the more traditional method and involves a vertical incision along the breastbone. While more invasive, it provides the surgeon with direct access to the heart and is often used in complex cases or when other heart defects are present. After the repair is completed, the sternum is wired back together, and the incision is closed with sutures or staples.

Postoperative Care and Recovery

Regardless of the surgical approach, patients are closely monitored in the intensive care unit (ICU) following the procedure. Recovery time varies depending on the type of surgery performed, but most patients can return to normal activities within a few weeks. Regular follow-up appointments with a cardiologist are essential to ensure proper healing and long-term heart health.