The left and right sides of the heart have different pumping functions. The right side of the heart collects deoxygenated blood from the body and pumps it to the lungs while the left side collects oxygenated blood from lungs and pumps it to the body. In order to carry this oxygen-rich blood properly, the halves of the heart should be divided from one another. This is achieved by a musculo-membranous (consisting of muscle and biological membrane tissue) wall called a cardiac septum.
A ventricular septal defect is also a congenital heart defect where there is a hole in the wall (septum) between the two lower pumping chambers of the heart. An example of this is an atrial septal defect (ASD), a congenital heart defect where there is a hole in the wall (septum) that separates the top two chambers (halves) of the heart. Although many of these defects, and especially ASDs, close themselves during early childhood, signs of heart failure, growth retardation or other systemic complications mean that the condition may still have to be treated as soon as possible.
For ASD or VSD correction, a minimally invasive cardiology or cardiovascular approach can be applied. For smaller ASDs and VSDs defects, surgery and other treatments may not be needed and can often be tentatively monitored without surgery. For more complex cases and larger defects, cardiovascular surgery is the first choice of treatment. Thanks to recent advances and the training of specialist surgeons, most cases can be treated with a minimally invasive surgery in which the sternum (chest) is not opened and instead an endoscopic approach is performed through a small incision in the armpit. This technique reduces the hospitalization and recovery time, and is more comfortable for the patient when compared to classical surgery.
Symptoms can develop in early childhood or later in life depending on the size of the defect. Patients with larger ASDs and VSDs are more likely to develop a heart failure or a heart stroke. Patients may experience shortness of breath, fatigue, a decrease in exercise capacity. Closing a large septum defect (ASD or VSD) by open-heart surgery usually is performed in childhood to prevent complications in the future.
How Can ASDs And VSDs Be Closed By Minimally Invasive Surgery?
The most common surgical approach requires the surgeon to open the breastbone in order to directly access the heart. Although this approach provides excellent access to the heart, the post-operative wound requires several months to heal completely, a long recovery period, and has a risk of serious complications including infection, breakdown, and even death.
Minimally invasive surgery can be performed to close all septal defects, allowing the procedure to be performed through small incisions and without stopping the heart, opening breastbone (sternum) or requiring a heart-lung machine to be used.
By using specialized endovascular catheters and endoscopic techniques, the surgeon gains access to the heart and the septum safely through small incisions in a relatively bloodless manner. This technique is less traumatic for the patient, meaning that recovery time is faster and there are fewer post-operative complications. In some cases, a robot is used to assist the surgeon while performing the minimally invasive septum defect closure.
How is it performed?
The surgeon’s hands control the movement and placement of the endoscopic instruments, which are used to sew a small patch of fabric or pericardial tissue over the septum defect to close it completely. Some defects can be sewn closed without a patch.
The pericardium is the thin sac that surrounds the heart. The normal heart lining will grow to cover this patch and it becomes a permanent part of the heart itself.
What Happens After My Minimally Invasive Defect Closure Surgery?
Regular medical follow up will be needed.
Patients may experience less pain and may have better ability to cough, breathe deeply and move after the operation so they are often discharged from the hospital in 2 to 3 days, compared to the typical 5 to 10 days for conventional surgery.
Patients can easily look after their daily needs by themselves as they will be able to use their arms and feel less pain. They can also travel with a plane, drive shortly after the surgery and wear seatbelts without the fear of getting any impact on their chests.
After these surgeries which are performed from under the armpit, even the patients themselves may not see post-operative scars. The scars become invisible in a period of just one month.
Since the incisions are minimal and there are no bone cuts, infection risks are also minimized