interatrial communication repair
Definition
Atrial septal defect (ASD) or inter-atrial communication (ASD) is a common congenital heart defect. It corresponds to the persistence of a dehiscence in the interatrial septum (partition which separates the two atria), normally hermetic after birth.
This abnormal communication is responsible for the appearance of a left-right shunt: part of the blood returning from the lungs in the left atrium returns directly to the lungs (via the CIA and the right atrium) by bypassing the great traffic.
CIA accounts for nearly ten percent of congenital heart disease in children. Their incidence would therefore be close to 0.70 per thousand births (i.e. between 500 and 600 new cases each year in France). They are seen twice as often in girls as in boys.
Before birth
Due to the peculiarities of blood circulation in the fetus ( see fetal circulation), physiologically there is a wide communication between the right and left atria: the Foramen ovale. Through this communication, oxygenated blood coming from the placenta through the umbilical vein is directed preferentially to the fetal brain via the left atrium, left ventricle and ascending aorta. This significant supply of blood is also necessary for the development of the structures mentioned above. In its absence, they would only have to convey minimal blood flow from the lungs, i.e. only 7% of fetal cardiac output.
After birth
Normally these two communications close. The persistence of an interauricular communication is abnormal and results from:
Either the absence of closure of the oval foramen, called permeable foramen ovale (PFO or PFO - patent oval foramen - in Anglo-Saxon); It is not strictly speaking a "heart defect" but the persistence of a fetal physiological structure.
Either the presence of a real defect (constitutional defect) of the interatrial septum, called " atrial communication".
In both cases, this abnormal communication allows the passage of blood from the high pressure circuit (left atrium) to the lower pressure circuit (right atrium). Oxygenated blood, which was intended for the general systemic circulation, finds itself again in the pulmonary circulation, causing an overload of the latter and pulmonary hypervascularization.
Per cutaneous treatment
Implantation of an umbrella-type device (Amplatz) by catheterization. This technique, used for the first time in 1976, has been widely used since 1992. It consists of introducing a retracted prosthesis horizontally into a vein in the leg and then guiding it into the heart. Arrived at the communication level, it is deployed on both sides of the hole like a "yoyo".
Surgical treatment
Closure by direct suturing, or using a prosthesis during heart surgery, to open heart, the first intervention of this type having taken place in 1952. surgical treatment is currently practiced for contraindications to percutaneous treatment:
Interauricular communication of non-ostium secondum type.
In communications of the ostium secundum type, the one whose measurement of the banks does not make it possible to hang the prosthesis.
Infants and young children because the diameter of the catheters used does not allow them to be introduced into the vessels.
The surgical treatment for CIA and CIV is open heart surgery. The heart is stopped and opened, and the hole is closed with a synthetic material such as Dacron or a piece of pericardium (the thick sac that surrounds the heart). Complications are minimal and the length of hospital stay is about three days.
Complications
Complications are those associated with any open heart surgery. For VSDs, there is also a low risk of heart block due to damage to the conduction system of the heart (1% risk). A pacemaker may therefore need to be inserted.
Conclusion
Many AICs can be closed without surgery. This is done by inserting an occlusion device in the cath lab. This procedure does not require a surgical incision and leaves no scars. This is often a one-day procedure, although sometimes your child may need to spend the night in the hospital. The use of this device depends on the size of your child and the size and location of the hole.