Hole In Heart Surgery Risks And Prevention

Hole in the heart is a congenital medical condition present during birth. Medically these conditions are known as Atrial Septal defect and Ventricular septal defect depending upon the part of the heart where the hole is present. These conditions may have an impact on healthy life and the patient may experience difficulty breathing, difficulty speaking and there may be a delay in developmental milestones. The condition can be treated with surgery. Like other major surgeries, there are various hole in heart surgery risks.

Hole In Heart Surgery Risks

• Hole in the heart is the general term used for two conditions medically known as Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD). These are congenital disorders and are present with birth in patients. It is to be noted that in the normal developmental scenario, the hole in the wall separating ventricles is closed before birth while the hole in the wall separating atrium is closed few days or months after birth. Non-closing of the hole at a suitable time causes a hole in the heart. If the hole in the wall separating atrium does not get closed and continues with a similar size, the condition is termed as patent foremen ovale.
• If the hole gets bigger and also have an abnormal muscular septum, the condition is known as Atrial Septum Defect. In both cases, if the hole is large enough, the heart and lungs have to work more.
• Effects of a hole in the heart during the initial period may be a murmuring sound that can be heard with the help of a stethoscope. Symptoms of VSD are more pronounced than ASD and includes murmur sound, difficulty breathing, difficulty feeding, and trouble to grow at a normal rate. In such cases, it is prudent to consult a cardiologist. Chronic VSD and ASD may result in damage to lung arteries as they are under severe stress due to excessive blood being pumped by the heart to lungs.
• The corrective treatment for both these conditions is open-heart surgery. This is major surgery, and like other major surgeries, open heart surgery has various complications. As the surgery involves one of the most vital organs of the human body, cardio-surgeon should be exceptionally accurate, precise and careful while performing surgery.

Following are some of the risks associated with open-heart surgery for ASD and VSD

1. Infectious Endocarditis

Although rare, bacterial endocarditis is one of the serious complications occurred during septal defect surgery. Patient with other underlying cardiac conditions is more prone to these infections. Such patients include patients with valve disease and pacemaker leads. Risk of endocarditis remains for at least 6 months after surgery.

2. Device Displacement

Device displacement occurs when transcatheter occlusion devices are used. With an experienced surgeon, the chances of device displacement are less than 1%. Malpositioning and embolization occur due to improper device placement or abnormal size.

3. Post-Implantation Arrhythmia

Surgery for atrial septal defect involves the long-term increased risk of atrial fibrillation or flutter. The chances of occurrence of this condition are almost 1-4%. These disorders are mild and require monitoring. The risk increases with an increase in the size of

4. Thrombus Formation

Various factors increase the risk of thrombus formation during surgery for a hole in the heart. This includes the type of device, insufficient antithrombotic treatment, and undiagnosed coagulation disorders. The overall incidence for this complication is around 1.2% out of which almost 70% cases occurring in the first month of surgery.

5. Device Erosion

The rate of device erosion is 0.1% and may lead to fatal consequences in almost 10% of cases. Use of oversized device and poor rim are risk factors. The erosion of the device generally occurs at the aortic root.

6. Cardiac Perforations

Symptoms experienced by the patient with cardiac perforations after surgery are chest pain, hemodynamic collapse and shortness of breath. Out of total cases of cardiac perforations, almost 70% of cases occur after discharging the patients from hospitals.

Other Complications

Other complications in surgery for heart in the hole are a transient ischemic attack, pericardial effusion, cyanosis, pulmonary hypertension, and Paradoxical embolization.

Sudden Death

Most complications require immediate medical intervention and long-term monitoring. Delay in treatment may result in fatal consequences in cases such as cardiac perforation and congestive heart failure.

How To Control Hole In Heart Surgery Risks

Most risks in ASD and VSD surgeries can be controlled by following the standard protocol related to surgery. The comprehensive medical evaluation should be done before deciding on surgery. Medical history and underlying medical condition should be critically evaluated to lower the risk during or after surgery.

To reduce the surgical complications related to the device, proper sizing and optimum device placement is required. The surface of the device should undergo complete neoendothelialization and sufficient antithrombotic treatment should be provided to the patient.

Aortic rim or superior rim should be evaluated for any deficiency to reduce device erosion. Comprehensive antibiotic prophylaxis should be initiated to prevent infective endocarditis.

Conclusion

The various risk associated with ASD and VSD surgeries includes Post-implantation arrhythmia, cardiac perforations, infective endocarditis, device erosion, congestive heart failure, pulmonary hypertension, thrombus formation, device displacement, and sudden death. Risk can be reduced by strictly adhering to all the protocols, evaluating the medical history of the patient and initiating antibiotic prophylaxis.