eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Atrial Septal Defect, Sinus Venosus: Follow-up

Author: Gary M Satou, MD, FASE, Director, Pediatric Echocardiography, Mattel Children's Hospital at University of California at Los Angeles; Associate Clinical Professor, Department of Pediatrics, David Geffen School of Medicine at University of California at Los Angeles
Coauthor(s): Brian L Reemtsen, MD, Assistant Professor of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California
Contributor Information and Disclosures

Updated: Jun 12, 2009

Follow-up

Further Inpatient Care

  • Patients with sinus venosus atrial septal defect (ASD) require a brief postoperative admission to a pediatric cardiac intensive care unit. The patient who undergoes uncomplicated surgical repair is usually discharged home within several days.
  • Patients in heart failure may require short-term continued support until pulmonary edema resolves, myocardial function improves, and until pulmonary vascular resistance, if elevated, normalizes.

Further Outpatient Care

  • Postoperative follow-up: This usually involves an office visit with the pediatric cardiologist (and possibly the cardiac surgeon) 1-3 weeks after hospital discharge.
    • Echocardiography is used to effectively evaluate the repair for evidence of residual shunting, superior vena cava (SVC) or pulmonary vein obstruction, pericardial effusion, and ventricular function.
    • The potential for late postoperative narrowing of the SVC is observed after repair of sinus venosus atrial septal defects.
    • Sinus node dysfunction screening should be part of outpatient follow-up care as sinus node dysfunction may become apparent years after repair of a sinus venosus atrial septal defect.

Inpatient & Outpatient Medications

  • No long-term medication is required after repair of an uncomplicated atrial septal defect. Some surgeons prescribe aspirin or other anticoagulation regimens for several weeks in patients in whom a prosthetic patch was used to close the defect. This allows for endothelial ingrowth over the thrombogenic surface of the patch. Long-term anticoagulation is not indicated.
  • Antibiotic prophylaxis is not required in patients who have had atrial septal defects repaired.

Transfer

  • Patients with a sinus venosus atrial septal defect should be transferred to a center experienced in the repair of such a defect in children or adults.

Complications

Prognosis

  • As discussed above, the prognosis is excellent for young patients who undergo repair of uncomplicated defects. Repair delayed until the third decade of life is associated with a decrease in life expectancy.

Patient Education

  • Patient education mainly focuses on preoperative and postoperative care and recovery, which are especially important in young children undergoing surgery. Centers with experienced child life personnel are invaluable in preparing children for open-heart surgery.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider atrial septal defect in infants and children diagnosed with failure to thrive may lead to a missed diagnosis.
  • A delay in diagnosis of an atrial septal defect until the third decade of life is associated with decreased life expectancy.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Jeff L Myers, MD, PhD, and James Jaggers, MD, to the writing and development of this article.



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References
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References

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Further Reading

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Keywords

sinus venosus, atrial septal defect, ASD, superior vena cava type subcaval ASD, SVASD, atrial septum, congenital heart defect, congenital cardiac anomaly, congestive heart failure, murmur, treatment, diagnosis, heart problems, heart disease, heart anomaly

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Contributor Information and Disclosures

Author

Gary M Satou, MD, FASE, Director, Pediatric Echocardiography, Mattel Children's Hospital at University of California at Los Angeles; Associate Clinical Professor, Department of Pediatrics, David Geffen School of Medicine at University of California at Los Angeles
Gary M Satou, MD, FASE is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Society of Echocardiography, and Society of Pediatric Echocardiography
Disclosure: Nothing to disclose.

Coauthor(s)

Brian L Reemtsen, MD, Assistant Professor of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California
Brian L Reemtsen, MD is a member of the following medical societies: American Medical Association, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Charles I Berul, MD, Associate Professor of Pediatrics, Harvard Medical School; Senior Associate, Department of Cardiology, Children's Hospital of Boston
Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Alvin J Chin, MD, Professor of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
Alvin J Chin, MD is a member of the following medical societies: American Association for the Advancement of Science and American Heart Association
Disclosure: Nothing to disclose.

CME Editor

Gilbert Z Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center
Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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