Surgical Options for Atrial Septal Defects
What is an ASD?
An Atrial Septal Defect is a hole, or defect, in the septum dividing the two top chambers of the heart, called atria, thus the name. The blood flows through the hole from one side of the heart to the other. When the blood is returning from the lungs full of oxygen some of it goes through the hole and back to the lungs again, possibly causing pulmonary hypertension and depleting the body of a portion of the oxygen rich blood it needs. This causes the person to have a lowered stamina and may cause growth and development problems if the hole is large. The abnormal flow of blood through the hole can cause a clot to form which can then embolize and go to anywhere in the body, causing a stroke or heart attack among other things. The severity and type of symptoms one may have are directly related to the size of the hole, as is the treatment for it. There are several surgical options available, some you may not even hear about. That is the reason for what I am going to write about here.
Just to set the record straight, I am not a doctor. I am someone going through this right now, who has done several hours of research on the topic, speaking to several surgeons as well. I have an ASD that is teardrop shaped and is a little over 3.5 cm long and about 1.5 cm wide.(see pic) I have already went in for a surgical catheter device procedure which was unsuccessful because this is a large ASD, and am seeing more surgeons about another surgery. The types of surgery available are a concern for me, and I want everyone to be aware of all of their options. That is what prompted me to write this article.
Surgical Options, What's Needed, What's Not
Once you have been found to have an ASD, they typically send you to a cardiologist, or cardiac surgeon to determine what the next best course to take is. There is some discrepancy whether they even need to repair smaller ASD's under 1/2 cm, but that is not what I am here to discuss. The first line of defense, once surgery is deemed necessary, is the catheter and placement of a device which snaps shut over the hole from both sides, then your heart grows over it in time. (more info on the device below) A very detailed description of this type of surgery can be found HERE : http://my.clevelandclinic.org/disorders/atrial_septal_defect/hic_how_is_an_atrial_septal_defect_asd_closed_using_a_catheter-based_procedure.aspx ....... One thing you will notice on that webpage is the omission of the third surgical option I mentioned, robotic surgery. It has been used for ASD's for 10 years now, and has a very good track record. With the robotic surgery, instead of a 14 inch incision in the middle of your chest including cutting through your breastbone, you have a 3 inch incision under your right arm, and no cutting bones. As a result of these factors, your hospital stay is a couple days shorter, and there is a lot less blood loss ( who wants a transfusion? do you have any idea how dangerous those are?) plus the added benefit that you are back to normal in a couple weeks instead of a couple months!
Why isn't every surgeon doing it this way? The answer to that lies in an old but very true saying, follow the money. Most insurers will put up a fight about doing it robotically simply because of the cost. ( although to be sure if it was them or their loved one robotic surgery would be what they would get ) Some insurers simply refuse to allow it, once again, because of the cost. As usual, their money trumps our safety, pain and suffering, as well as our very lives. In the unlikely event you need this or any surgery, push your surgeon, and hospital for the robotic surgery, and don't take no from your insurance company! There is a better way to repair ASD's as well as many other surgeries, robotic surgery. Ask for it by name.
I had the surgery, and the surgeon changed the procedure at the last moment. What we agreed to do is called a Right Anterolateral Thoracotomy. It is basically the same operation the robot was going to do, only there was no waiting on the robot. They make a 4-5 inch incision under the right breast, and go in with "chopstick" style instruments to repair the ASD. I have read and been told that the pain is worse for this than the traditional "down the middle" approach to the heart. I had very little pain myself, but it is generally agreed that post operative recovery is half the time or less, and it has been very quick in my case. I actually do feel years younger in many ways, and recommend the surgery. (Make sure they keep you "out" until the breathing tube is removed as that was HORRIBLE!)
Links to More info.
- GORE® HELEX® Septal Occluder
another type of device to plug the hole.
- Atrial Septal Defect - YouTube
This video shows the occluder device and how it is placed in the heart.
- Mayo Clinic ASD procedures video Dr. Burkhart, surgeon