Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) Repair

A hole in the wall between the two upper collecting chambers (ASD) or between the two bottom pumping chambers (VSD) can cause problems. The severity of the symptoms depends on the size and the location of the defect and can range from no symptoms at all to severe heart failure. Heart failure in a baby results in poor feedings and poor weight gain. In older children, heart failure may cause decreased exercise tolerance and shortness of breath.

Depending on their size and location, septal defects may close by themselves. The cardiologist will likely wait a while before recommending surgical treatment to see if that happens naturally. In cases involving larger holes and severe symptoms, however, treatment with surgery or catheter closure with a device will be needed.

The surgical treatment for ASDs and VSDs is open-heart surgery. The heart is stopped and opened, and the hole is closed with a patch made of a synthetic material like Dacron or a patch of pericardium (the thick sac that surrounds the heart). Complications are minimal and the length of stay in the hospital is about three days.

Complications are the ones associated with any open-heart surgery. For VSDs, there is also a small risk of heart block by damage to the heart's conduction system (1% risk). This could require a pacemaker insertion.

Many ASDs can be closed without surgery. This is done by inserting an occluder device in the catheterization laboratory. This procedure does not require a surgical incision or leave a scar. It is often a day procedure, although sometimes your child stays overnight in hospital. Use of this device depends on the size or your child and the size and location of the hole. 

For more information, please read Closure Device Insertion.

Jennifer Russell, MD, FRCPC