Introduction
An atrial septal defect (ASD) is a hole in the wall between the two upper chambers of the heart. A ventricular septal defect (VSD) is a hole in the wall between the two lower chambers. Both are usually present from birth.
These holes let blood flow between the left and right sides of the heart, which can overload the heart and lungs. Surgical closure repairs the hole directly, using stitches or a patch.
Why the procedure is needed
Depending on the size of the hole, an ASD or VSD may cause:
- Breathlessness and tiredness, particularly on effort
- Poor weight gain, frequent chest infections or fast breathing in children
- Palpitations or irregular heartbeat, especially with ASD in adults
- Enlargement of the right side of the heart and high pressure in the lung blood vessels over time
- In some cases, stroke caused by a clot crossing the hole, or other serious complications
Who may benefit
- Children and adults whose ASD or VSD is large enough to overload the heart or lungs
- Patients with symptoms, or with signs of heart enlargement on tests
- Patients whose defect is not suitable for closure with a catheter-delivered device — for example because of its size, position or other heart problems
- Patients needing other heart surgery at the same time
- Closure is generally not advised when lung pressures have become so high that closing the hole would be harmful — your cardiologist will check this
Types of defect and ways to close them
- Atrial septal defect (ASD)
- A hole between the upper chambers. Small ones may not need treatment; larger ones are closed to prevent heart enlargement, rhythm problems and other complications.
- Ventricular septal defect (VSD)
- A hole between the lower chambers. Some small ones close by themselves in childhood; larger ones need closure so that the lungs and heart are not overloaded.
- Direct stitches
- A small defect may be closed by stitching its edges together.
- Patch closure
- A larger defect is closed with a patch made of the patient's own tissue or an artificial material, stitched over the hole.
- Catheter closure
- Some defects can be closed with a device placed through a vein, without open surgery. Surgical closure is used when this is not suitable.
Procedure overview
Step 1: Assessment
Echocardiography and, where needed, catheter studies, CT or MRI show the size and position of the hole, how much blood crosses it and the pressure in the lungs.
Step 2: Anaesthesia
General anaesthesia is used for all ages.
Step 3: Surgical access
The heart is reached through the breastbone, or through a smaller incision in suitable patients. The heart-lung machine takes over circulation.
Step 4: Closing the defect
The heart is opened, and the hole is closed with stitches or a patch. Air is carefully removed from the heart.
Step 5: Checking and closing
After the heart restarts, the repair is checked, often with an echo, before the chest is closed.
Step 6: Postoperative monitoring
Intensive-care monitoring follows, then ward care. Follow-up echocardiography checks that the hole is closed and the heart is recovering.
Clinical advantages
- Closes the hole and stops the abnormal flow of blood between the chambers
- May relieve breathlessness and tiredness and allow normal growth and activity in children
- May protect the heart and lungs from long-term damage when done at the right time
- In many patients, surgery leads to a normal or near-normal life with regular follow-up
Risks and considerations
Every operation carries risk. The points below are general; your own risk depends on your health and on the operation you need.
- General risks of open-heart surgery: bleeding, infection and reactions to anaesthesia
- Temporary rhythm problems, and in a small number of patients a need for a pacemaker, particularly after VSD closure
- A small leftover hole or leak around the patch, which usually needs only follow-up but sometimes more treatment
- Fluid around the heart or lungs after surgery
- Risks are higher when lung pressures are high, or when other heart problems are present
Frequently asked questions
Do all ASDs and VSDs need an operation?
No. Small defects that cause no problems may only need regular check-ups, and some VSDs close by themselves in childhood. Your cardiologist will advise.
Why is surgery sometimes used rather than a catheter device?
Some holes are too large, in the wrong position or occur with other heart problems, so they cannot be closed safely with a device.
How long is the hospital stay and recovery?
Hospital stay is often around five to seven days, and children and adults usually return to normal activity in a few weeks to a couple of months. This varies from patient to patient.
Will my child lead a normal life?
Many children do very well after closure and can take part in normal activities, but regular follow-up with a paediatric cardiologist remains important.
What follow-up is needed?
Check-ups with echocardiography after surgery and then at intervals your doctor advises. Report breathlessness, fever, swelling or palpitations.
Patient-friendly summary
ASD and VSD closure repairs a hole in the heart with stitches or a patch so that blood flows the right way. It can protect the heart and lungs and allow a normal life, but only a cardiologist can say whether a hole needs closing, and when. Follow-up after surgery is important.