David Meyer MD Pediatric Cardiothoracic Surgeon explains Atrial Septal Defect.
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Male Speaker: What's a ASD? Male Speaker: An ASD is a hole between the two collecting chambers of the heart which are called atria. There is a left atrium which collects blood from the lung and there is a right atrium which collects blood from the body. Blood should not mix between those two chambers, but in case, if there will be a hole between those chambers and different locations along that atrial septum, the valve between the two atria and that's called an atrial septal defect. Male Speaker: Do these have to be corrected? Male Speaker: Very small atrial septal defects might not need correction, but the majority of them do require correction at some point. Male Speaker: Is there a way of doing it with a catheter as opposed to a major surgical procedure? Male Speaker: One of the types of atrial septal defects, in fact the most common type, a Secundum type atrial septal defect which exit right into the middle of the atrial septum. The majority of closures these days are done with catheter based devices which are basically umbrella type or mushroom shaped plugs that are put from within the blood stream into the hole and they open up and they pop open and occlude the hole. Male Speaker: If you do put that kind of device in, and it's obviously not part of your body, the person has to go on anticoagulants for a certain period of time? Male Speaker: Generally, the patients are placed on some sort of antiplatelet medications whether it's Aspirin or Plavix for a short period of time, but long-term therapy is not needed. Male Speaker: The reason of that is some kind of membrane material overgrows the area? Male Speaker: The devices are designed such that the body covers them with its own lining of tissue and the devices become in fact relatively invisible to the body in a short period of time. Male Speaker: What would be the ones that you eventually have to do surgery and what would be the criteria? Male Speaker: Well, there are two situations that we do surgery for atria septal defects. For Secundum type atrial septal defect we would operate on patients for whom devices are not appropriate and those are patients in whom the ASD is extremely large and the device either might not exist in enlargement of size or it would be so large that it would risk injuring the heart in someway or poking outside the heart, poking into one of the other cardiac structures. Sometimes also the Secundum atrial septal defects will not have an adequate rim, this is the term that we use, but it will not have an adequate amount of tissue around it for the device to anchor. The device needs a certain amount of tissue to hold itself onto. So if the device is not technically possible or it's felt to be of significant risk to the patient, then surgery is a better option. In addition, there are other types or atrial septal defects, including a primum which is located down near the valves that separate the atrial from the ventricles and also there is a sinus venosus type which is located very high in the atrial septum and generally involves some abnormalities of the vein that bring back blood from the lungs. In those two cases the device closure is not appropriate and surgical closure is still required. Male Speaker: How complicated is the surgery? Male Speaker: Surgery for atrial septal defects of any kind is quite straightforward and is done with a less than one percent risk to the patient in any significant long-term sequela and generally with quite short hospitalization. Male Speaker: Do they have to go on a heart-lung machine? Male Speaker: The patient do have to go on a heart-lung machine for us to close these atrial septal defects, but particularly for young patients without any significant comorbid disease, in other words without any significant any medical problems, the risk of the heart-lung machine in modern time is extremely well and in fact the use the heart-lung machine makes any operations on the heart much safer to the patient.
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