Eligibility
Most patients with an ASD are candidates for a minimally invasive approach.
Preparation
Before the procedure, your doctor may order diagnostic tests, such as MRI and CT scans, to obtain images of your heart.
We'll also help you schedule an appointment with UCSF's Prepare Program, where staff will evaluate your medical history and ensure that you're ready to undergo the chosen procedure. This appointment may include a brief physical exam, additional medical tests, and discussions about anesthesia and pain control.
Procedure: Minimally invasive surgery
Minimally invasive ASD closure usually takes between five and six hours. You are under general anesthesia (completely asleep). A heart-lung machine is inserted through a small incision in your groin. This supports your organs and allows the surgical team to briefly pause the beating of your heart later in the operation.
Your surgeon starts by making a 4- to 6-centimeter incision on the right side of your chest between two ribs. A soft surgical device, called a retractor, is used to gently separate the ribs to allow insertion of slender surgical instruments. The surgeon then inserts an endoscope – a flexible tube with a 3D camera on the end – to collect detailed images of your heart and the ASD.
Your surgeon accesses the ASD through an opening in the right atrium (one of the heart's two upper chambers). A small ASD can be stitched closed. For a larger ASD, the surgeon covers the hole with a patch. The patch can be tissue taken from the pericardium (the sac surrounding the heart) or made from synthetic materials, such as Dacron or Teflon. While sewing the patch into place, your surgeon temporarily stops your heart from beating and uses the heart-lung machine to keep blood flowing to your organs.
Procedure: Cardiac catheterization
If your ASD is small enough, it can be closed using a catheter. Instead of making an incision in your chest, your doctor makes a small incision in the groin and gently guides the catheter through your blood vessels up to the heart. The procedure takes about three hours and may be done under general anesthesia or using sedatives that relax you but allow you to remain conscious.
During the procedure, your doctor uses imaging, such as X-rays or echocardiography, to guide the catheter through your blood vessels. After measuring the ASD and checking for other heart defects, your doctor feeds a small synthetic patch or closure device through the catheter and into the heart. The patch or device expands to cover the ASD; the catheter is then removed.
Recovery
With the minimally invasive surgery, you spend three to five days recovering in the hospital. You may spend the first night in the intensive care unit. During your stay, our team closely monitors your condition and watches for signs of infection. We track your blood pressure, breathing and heart rate; manage your pain; and get you up and walking promptly to improve blood flow and speed healing.
If you have ASD closure via cardiac catheterization, you're able to leave the hospital either the same day or the day after.
Everyone heals differently, but most patients can return to their regular activities within six to eight weeks. It's normal to feel tired or winded during the day, and you may feel sore across your chest, neck and back.
Follow-up care
Before you leave the hospital, we'll provide you with detailed instructions on how to continue recovering at home.
You can rest throughout the day when you feel tired or out of breath, but try to limit the length of daytime naps. Your goal should be to gradually increase your activity level as you heal. At night, propping yourself up with pillows may make sleep more comfortable.
To reduce soreness in your upper body, use the same approach you would for sore muscles: Apply heat and ice alternately, move and stretch periodically, and take pain medication as needed. If you have an incision on your leg, some swelling is normal; to bring it down, walk as much as possible and elevate your legs when sitting.
Caring for your incision
Your incision may be sore, itchy or slightly numb, and may look red or bruised. These are normal phases and should resolve within a few weeks.
To care for your incision:
- Gently wash the incision with warm water and mild soap, then lightly pat dry with a clean towel.
- You can shower, but don't take baths or soak the area until your wounds are completely healed.
- The adhesive strips covering your incision should fall off in three to 10 days. If they don't, gently pull them off in the shower.
If you have stitches or staples, a medical provider should remove them in 10 to 14 days.
What to eat after surgery
Nourishing your body is a key part of a smooth recovery. Even though you may not feel hungry, try to eat small meals throughout the day. Your postsurgical diet should:
- Be low in sodium. Too much salt can cause swelling and fluid buildup in your limbs and lungs. Don't add salt to your food.
- Be low in fat and high in lean protein.
- Include eight glasses of water per day (unless your doctor tells you otherwise).
Resuming physical activity
In the weeks after your surgery, you can gradually increase your activity level until you're back to normal. Pace yourself, starting with light activity around the house and short walks. Keep these pointers in mind:
- Walking is the most important activity following heart surgery. Aim for three or four walks a day, and feel free to take them outside. As you feel ready to do more, start by increasing your distance, then your speed.
- Keep your activity at a level where you can carry on a conversation. If it's difficult to talk, slow down. Rest if you need to.
For additional support, we may refer you to the UCSF Cardiac Rehabilitation and Wellness Center.
