An atrial septal defect (ASD) is a congenital defect where there is an opening in the wall between chambers (atria) of the heart. There are minimally invasive approaches to fixing an atrial septal defect, but it depends on the size, shape, and location of the defect. A small defect can be conservatively followed without surgery. But a larger one does need surgery.
The most common surgical approach requires the surgeon to open the breastbone and spread the edges for direct access to the heart. There are several minimally invasive surgical options available depending on the type of ASD and the specifics of the patient’s anatomy. Options include a mini-thoracotomy, partial sternotomy (or partially opening the breast-bone), and robotic approaches.
A mini-thoracotomy consists of a three-inch incision made through the right side of the chest between the ribs. The heart-lung bypass, required to stop the heart long enough for the surgeon to close the defect, is instituted with small tubes placed in the main artery and vein of the leg through a one to two inch incision placed in the right groin crease. The heart will then be stopped and the right atrium opened to expose the ASD. At this point, the surgeon will insert specialized instruments through the incision to repair the defect. Once the defect is repaired, the heart will be closed and restarted. The heart-lung machine is disconnected and the incision is closed.