An Atrial Septal Defects (ASD) is a hole in the membrane separating the upper heart chambers.
The opening is necessary for a baby's circulation while in the mother's womb, but is expected to
close at birth. If this passage does not close at birth, a hole remains and can persist throughout
a persons adult life. About 10% of adults have a small opening (called a Patent Foramen
Ovale or PFO). Larger openings are called Atrial Septal defects.
ASDs and PFOs are normally silent, in that they do not cause symptoms. However, in some
cases, important symptoms can occur which require closure of the defect. The most
important, and threatening complication of an atrial septal defect is a stroke. The opening
can permit clot or air from the right side of the heart to cross over to the left side of the heart
under certain circumstances. This process is called a "paradoxical embolism". Although some
may be silent, a paradoxical embolism may also be associated with a heart attack or stroke.
If neurologic symptoms occur in the presence of a PFO or ASD, closure of the defect is
recommended.
Surgical closure of an ASD is one of the oldest and most established procedures in cardiac
surgery. The invention of the heart-lung machine has made it possible to open the upper heart
chamber and suture the defect closed. The mortality rate for surgical closure of an ASD or
PFO is less than 1% and the expected complications are minimal. Most patients can be
discharged home in a few days.
Traditional surgery for ASD or PFO closure has been performed by dividing the breast bone (an
incision called "median sternotomy"). Since most ASDs are not associated with any other
cardiac defect and are simple to repair, there have been many alternative incisions proposed in
order to minimize the cosmetic appearance of the surgical scar. The principle alternative
incision is a "thoracotomy" (between the ribs) in the right chest, with or without the assistance
of scopes or robotically controlled instruments.
Another alternative incision was developed by Dr. Mark Levinson in Hutchinson, Kansas. The
subxiphoid approach places the incision in the upper abdomen and can even be hidden in the
breast fold of female patients. The sternum is not divided. Instead, the breast bone is lifted
forward, exposing the right side of the heart where the defect can be closed with either sutures
or a patch.
Advantages of the subxiphoid incision as opposed to traditional surgery include:
1.
No visible scar on the front of the chest
2.
Much smaller incision
3.
Less pain
4.
No splitting of the breast bone
5.
No spreading of the ribs
6.
Early return to full activities
If you wish to learn more about subxiphoid ASD or PFO closure, click the links below
