ASD and VSD Closure Surgery Procedure

Introduction

Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) are congenital heart conditions that involve an abnormal opening in the septum the wall that separates the chambers of the heart. In ASD, the opening lies between the two upper chambers (atria), while in VSD, the defect is between the lower chambers (ventricles). These openings allow oxygen-rich and oxygen-poor blood to mix, which can put unnecessary strain on the heart and lungs over time. Below are the main steps and techniques involved in the ASD and VSD closure surgery procedure.

While some small defects close naturally during childhood, larger or persistent ones require surgical intervention or catheter-based closure. The primary goal of the procedure is to eliminate the abnormal blood flow between the heart chambers, restore proper circulation, and prevent long-term complications such as pulmonary hypertension, heart failure, arrhythmias, or stroke. The approach to ASD and VSD closure varies depending on the size and location of the defect, the patient’s age, symptoms, and overall health.

ASD and VSD Closure Surgery Procedure

1. Preoperative Evaluation and Imaging :- Before any closure procedure is performed, a thorough evaluation is conducted to assess the defect’s size, type, and effect on heart function. This process usually begins with a physical examination followed by diagnostic tests such as echocardiography (transthoracic or transesophageal), electrocardiogram (ECG), chest X-ray, and sometimes cardiac MRI or CT scan. Echocardiography plays a vital role in visualizing the septal defect and determining whether surgery or catheter-based closure is appropriate. It also helps evaluate chamber enlargement, pulmonary pressures, and the presence of additional anomalies. Blood tests and a complete medical history are also reviewed to rule out contraindications or complications. In some cases, cardiac catheterization is performed to directly measure pressures inside the heart and lungs. This preoperative planning ensures a safe and tailored surgical approach, minimizing risks and enhancing outcomes.

2. Anesthesia and Surgical Preparation :- Once the surgical plan is finalized, the patient is admitted for the procedure. Whether it’s an open-heart surgery or a catheter-based intervention, general anesthesia is administered to ensure the patient remains unconscious and pain-free throughout. In open-heart surgery, the patient is positioned on the operating table, and the chest area is thoroughly cleaned and sterilized. Sterile drapes are placed to maintain a clean surgical environment. The anesthesia team continuously monitors the patient’s vital signs, oxygen levels, and heart rhythm. If the patient is undergoing transcatheter closure, the femoral vein or artery is prepared for catheter insertion under sterile conditions in a catheterization laboratory. All necessary equipment and closure devices are readied before the procedure begins. This meticulous preparation phase is essential to ensure smooth execution and quick response to any complications.

3. Open-Heart Surgical Closure :- In traditional surgical closure, the surgeon makes an incision down the center of the chest (median sternotomy) to access the heart. Cardiopulmonary bypass is initiated, where a heart-lung machine takes over the circulation and oxygenation of blood during the procedure, allowing the heart to be temporarily stopped. The heart is opened, and the defect is directly visualized. Depending on the size of the opening, it may be closed using one of two methods primary suture closure for small holes or patch closure using synthetic material or the patient’s own pericardial tissue for larger defects. Once the closure is complete and the integrity of the repair is confirmed, the heart is restarted, and the patient is gradually weaned off the bypass machine. The chest is closed in layers with sutures or surgical staples, and sterile dressings are applied. Drainage tubes may be placed temporarily to prevent fluid buildup around the heart or lungs. Open-heart surgical closure is often chosen when the defect is large, located in a difficult position, or associated with other structural abnormalities that require correction.

4. Catheter-Based (Transcatheter) Closure :- For suitable patients, especially those with secundum ASD or muscular VSD, a less invasive transcatheter procedure can be performed. This approach involves threading a thin, flexible catheter through a vein (usually in the groin) and guiding it to the heart using fluoroscopy and echocardiographic guidance. Once the catheter reaches the defect, a specially designed closure device (often made of nitinol mesh) is deployed to seal the opening. The device has two discs that sandwich the septum and gradually become covered with tissue over time, providing a permanent seal. The procedure is typically completed within 1 to 2 hours, and patients can often go home the next day. There is no need for a surgical incision or heart-lung bypass. This method offers a quicker recovery, minimal scarring, and fewer complications, making it an attractive option for many patients. However, not all ASD and VSD closure types are suitable for catheter-based closure. The size, shape, and location of the defect must meet specific anatomical criteria, which are determined during preoperative imaging.

5. Postoperative Monitoring and Recovery :- After surgery or catheter-based closure, the patient is transferred to a recovery area or intensive care unit (ICU) for close monitoring. Vital signs, oxygen levels, and heart rhythm are continuously tracked. Pain management and antibiotic therapy are initiated as needed to ensure comfort and prevent infection. If an open surgery was performed, the patient may need to stay in the hospital for 5 to 7 days. In the case of a transcatheter closure, discharge often occurs within 24 to 48 hours. Activity is restricted for a few weeks, especially in open surgical cases, to allow the chest and heart to heal properly. Follow-up appointments are scheduled to assess recovery and ensure that the defect remains closed. Repeat echocardiograms are typically done to confirm device position or patch integrity and to evaluate heart function. Most patients recover fully and return to normal activities within a few weeks. Children can resume school, and adults can go back to work after medical clearance. Long-term outcomes are excellent, with minimal risk of complications if postoperative instructions are followed carefully.

Conclusion

ASD and VSD closure surgery is a well-established and highly successful procedure for treating congenital heart defects that involve abnormal openings in the heart’s septal wall. Whether performed as open-heart surgery or as a catheter-based intervention, the primary goal is to restore normal blood flow and protect the heart and lungs from long-term strain.

The process involves detailed preoperative evaluation, precise surgical or interventional techniques, and diligent postoperative care. With modern medical advances, these procedures have become safer, less invasive, and more effective than ever before. Choosing the appropriate closure technique depends on the size, location, and nature of the defect, as well as the patient’s overall health and symptoms.

Ultimately, timely closure of ASD and VSD leads to significantly improved quality of life, better heart function, and reduced risk of serious complications making it a life-changing intervention for many patients.