Keyhole Atrial Septal Defect (ASD) Repair

What is an Atrial Septal Defect (ASD)?

ASDs make up around 25–30% of congenital heart defects diagnosed in adults. It is a congenital heart defect whereby a hole is present between the two upper chambers of the heart.

When the hole is significant in size, it causes extra blood to flow abnormally from:

• The left atrium (higher blood pressure)
• To the right atrium (lower blood pressure)

Initially, it may not produce any noticeable symptoms. But over time, the increased blood flow to the right side of the heart puts strain on the lungs and raises blood pressure in the pulmonary arteries.

Eventually, the pressure on the right side becomes so high that the shunt stops, becoming what’s called a balanced shunt. A balanced shunt may sound stable, but it is a serious sign of an increased risk. It means the right side of the heart is under significant stress, and in some cases, treatment may no longer be possible.

If a large atrial septal defect is untreated, it can lead to further issues with the heart and the lung arteries and even shorten your life expectancy. Therefore, it’s important to undergo an ASD closure procedure as early as possible if necessary.

Not all patients will need to undergo ASD surgery, as very small defects can close spontaneously after a few years and not cause any complications or require treatment.

Learn more about surgery for atrial septal defects and gain a better understanding of this congenital heart disease through our comprehensive resources below. 

Types of ASD

ASDs are classified based on their location. There are three major types of ASDs:

1. Ostium Secundum ASD

Making up around 75% of ASDs, ostium secundum ASD is the most prevalent type of defect.

• Located in the fossa ovalis region, the central part of the atrial septum
• Considered a true defect of the atrial septum
• More frequently seen in females (65–75% of cases)
• May occur in isolation or with other cardiac anomalies

2. Ostium Primum ASD

Approximately 15% of ASD cases.

• Found in the lower portion of the atrial septum
• Part of the atrioventricular (AV) septal defect spectrum
• Often associated with:
  • A common AV valve
  • A large ventricular septal defect (VSD) (in the complete form)
• Equal gender distribution
• Also referred to as AV canal defects and endocardial cushion defects

3. Sinus Venosus ASD

Sinus venosus ASD are less common than secundum or primum types, accounting for around 10% of all ASDs.

• Typically located at the junction of the right atrium and the superior vena cava, where major blood vessels enter the heart
• Often associated with partial anomalous pulmonary venous return (PAPVR), a condition where some pulmonary veins (blood vessels from the lungs) drain into the right atrium instead of the left side
• Equal gender distribution

Rare Variants of ASDs

While less frequent, the following types may also be seen:

• Inferior vena cava (IVC) form of sinus venosus ASD: Located near the IVC and right atrium junction
• Coronary sinus septal defect, also known as an unroofed coronary sinus. Allows shunting from the coronary sinus to the left atrium, resulting in a left-to-right shunt

Cause

As with many heart issues, ASD is congenital, meaning they are present at birth. ASD occurs when the heart does not develop normally in the womb, but the cause of this is unknown.

At birth, it is normal to have openings in the upper heart chambers. However, these usually close within a few weeks or months after birth. An opening that does not close becomes an atrial septal defect.

Symptoms

If the hole is large, common symptoms include:

• Heart palpitations
• Shortness of breath
• Stroke
• Heart murmur
• Pulmonary hypertension
• Rare: Cyanosis (bluish skin tone)

When left untreated, ASD may lead to irregular heartbeats, heart failure and lung damage. It is therefore crucial to seek appropriate ASD treatment in order to prevent long-term effects.

Atrial Septal Defect Treatment

Treatment protocols for ASD depend on the size of the hole in the wall separating the left and right atria. Small children who have ASD may not need treatment if the defect is not causing any symptoms. However, if the defect is causing the heart to stretch and enlarge, surgery is usually recommended to close the hole.

There are two types of treatment available for ASD: the Amplatzer device closure method and keyhole ASD heart surgery. Both procedures aim to improve blood flow and lower your risk of serious complications like stroke or heart failure.

The best treatment differs from person to person, and the procedure chosen will depend on the size, location and severity of the defect. At our London Heart Clinic, we offer consultations for ASD that can help determine the best solution for you.

Amplatzer ASD Device Closure

In many cases, the hole in the heart can be closed without surgery via cardiac catheterisation using an atrial septal defect closure device.

At the Keyhole Heart Clinic, our expert interventional cardiologists use an AMPLATZER® Septal Occluder. This is a synthetic material closure device that is designed to fit snugly against the heart wall on both sides of the hole, creating a secure seal. Once in place, they provide a foundation for your body’s natural tissue to grow over them, permanently closing the defect.

1.  A long, thin tube (catheter) is passed through a vein in the groin under sedation, through to the heart.
2.  The catheter carries a collapsed closure device into the heart, which, when deployed, opens like an umbrella to close the defect.
3.  The closure device is opened to seal the hole
4.  The Amplatzer device remains permanently implanted, with heart tissue growing over it, so the device becomes part of the muscle wall.

Benefits of cardiac catheterisation:  

• Does not require open-heart surgery
• Minimal recovery time
• Performed under sedation, not general anaesthetic
• Patients tend to only need to be hospitalised for one day

However, Amplatzer Device closure using a catheter is not always possible if the hole in the heart’s chamber is abnormally large or difficult to locate.

The video below demonstrates the process of an Amplatzer Device closure.

Keyhole ASD Closure Surgery

A large defect, or one located in an abnormal position, often requires atrial septal defect surgery. While some procedures still require connection to a heart-lung machine, many can now be performed while your heart continues beating normally.

Keyhole ASD closure is a minimally invasive surgery. This is an alternative to traditional open heart surgery, where the breastbone would be broken and take months to heal

This ASD procedure can be performed between the ribs on the right side of the chest. This allows excellent repair of the defect, by either direct closure or using a patch which is carefully sewn into place. During the atrial septal defect closure surgery, you will be under general anaesthesia, and in other words, completely asleep.

At our London heart clinic and our other locations, we offer keyhole ASD closure if it is suitable for you.

There are many benefits of opting for keyhole atrial septal defect repair instead of traditional open-heart surgery, including:

• You will not need to have your breastbone divided, helping you heal within a few days rather than months.
• You will have no risk of bone infection and be able to resume your daily activities within a few days after your ASD closure.
• There is a much greater cosmetic appeal to using a keyhole ASD closure. You will be left with a much smaller scar due to the small incision site.
• Minimal pain and discomfort as there is no breastbone break.

• The healing process will be much more comfortable and milder in comparison to traditional surgery.

While complications are uncommon, they can include:

• Bleeding
• Irregular heart rhythm (arrhythmia)
• Infection at the device site or incision
• Kidney problems
• Stroke or mini-stroke (transient ischemic attack)

ASD Heart Surgery Aftercare

After your ASD procedure, following proper aftercare instructions is crucial for a smooth recovery and the best possible outcome.

• Activity restrictions: Your medical team will provide specific guidelines about physical activities during your recovery. The good news is that with the keyhole ASD closure procedure, these restrictions are typically much less limiting than with traditional surgery.
• Antibiotics: Patients with congenital heart conditions are at higher risk of developing endocarditis, a rare infection of the heart’s inner lining and valves. To reduce this slight risk, antibiotics may be recommended after ASD cardiac surgery, and in some cases, before dental procedures.
• Blood thinners: These medications help prevent blood clots from forming as your heart heals.
• Pain management: You’ll receive appropriate pain medication to keep you comfortable during recovery.
• Wound care: Proper care of your incision site is essential to prevent infection and promote healing.

To learn more about surgical ASD closure and more of what we do at the Keyhole Heart Clinic and our team, view our full video section.

The Keyhole Heart Clinic: Experienced Keyhole Surgery Team

At The Keyhole Heart Clinic, we can offer a less painful and quicker recovery solution to open heart surgery that can be suitable for those with an atrial septal defect that is large or in an obscure position.

We have an experienced healthcare team of specialised cardiac surgeons and interventional cardiologists. In addition to treating atrial septal defects with surgical ASD repair, we offer various procedures for other heart conditions, including:

• Keyhole coronary bypass surgery
• Keyhole mitral valve repair or replacement surgery
• Keyhole tricuspid valve replacement
• Keyhole aortic valve replacement
• Keyhole atrial fibrillation ablation

The clinic also offers heart screening services.

Please get in touch with us today to arrange a consultation or a remote appointment with our team, and we can discuss the right path for your ASD repair surgery or non-surgical treatment.