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
