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Atrial Septal Defects (ASDs) Surgery in Abuja



What is an Atrial Septal Defect or ASD defect in children in Nigeria?

Atrial septal defect (ASDs) is a type of congenital heart disease where there is a hole in the wall that separates the two upper chambers (atria) of the heart, called the atrial septum.

The interatrial septal defect allows blood from the left and right atria to mix, leading to decreased oxygenation of blood. The consequence is an increased workload on the right side of the heart and eventually, a heart failure.

Atrial septal defect (ASD) is a type of congenital heart defect that affects a large number of children in Nigeria. Small ASDs usually don’t need treatment. Larger ones may require nonsurgical (percutaneous) or surgical repair to lower the risk of complications.

How common are Atrial Septal Defects (ASD) among the Nigerian population?

Atrial septal defects are among the most commonly occurring congenital heart defects in children in Abuja, Lagos and Portharcourt. These defects occur in around 1 to 2 out of every 1,000 live births. In Nigeria, approximately 1 in every 1,859 babies is born with an atrial septal defect, which translates to about 2,118 babies born with ASD each year.

What are the four distinct types of Atrial Septal Defects (ASD) in Nigeria?

There are four main types of atrial septal defects based on their location in the atrial septum.

Secundum ASDs are the most common type of ASD is Secundum ASDs, which is located in the middle of the atrial septum and accounts for 80% of all ASDs.

Primum ASDs, on the other hand, are located in the lower part of the atrial septum, and babies with this type of ASD may also have other heart defects, which include endocardial cushion defect, atrioventricular septal defect, tricuspid valve defects, and mitral valve defects. This type of ASD is generally associated with Down syndrome.

Sinus Venosus ASDs located in the upper or lower back part of the atrial septum and this type is linked with defects in the right pulmonary vein or large veins in the heart called superior or inferior vena cava.

The rarest type of ASD is Unroofed coronary sinus, which accounts for less than 1% of all ASDs. It involves a missing or incomplete wall between the coronary sinus (a group of veins connected to your heart) and the left atrium. This type of ASD is more often linked with another complex congenital heart disease.

What are the causes of Atrial Septal Defects (ASD) in kids in Nigeria?

Causes of atrial septal defects are generally divided into two categories: genetic and environmental.

Genetic causes include:

·Chromosomal abnormalities such as Down syndrome, Turner syndrome, and Patau syndrome.

·Inherited genetic conditions such as Marfan syndrome, Loeys-Dietz syndrome, and Ehlers-Danlos syndrome.

·Mutations in specific genes such as TBX5 and GATA4

Environmental causes include:

·Exposure to certain medications or chemicals during pregnancy, such as alcohol, tobacco, and certain prescription drugs.

·Maternal illnesses such as rubella, lupus, and diabetes.

·Low birth weight or premature birth

·Excessive alcohol, Smoking and tobacco use during pregnancy

What are the medical conditions that are associated with Atrial Septal Defects (ASD)?

Certain heart defects and genetic disorders are commonly associated with atrial septal defects in newborns in Nigeria. Some of the heart defects that may coexist with an atrial septal defect are

·Mitral Valve Disease

·Pulmonary Stenosis, and

· Ventricular Septal Defect (VSD)

Additionally, some of the genetic disorders that may be linked to an atrial septal defect are

·Holt-Oram syndrome,

·Down syndrome

·Thrombocytopenia-absent radii (TAR) syndrome.

How does an Atrial Septal Defect (ASD) impact the children’s body?

Larger ASDs can put a strain on the right side of your heart. This is because the right side now has to pump more blood to your lungs due to the extra blood flow caused by the defect. Over time, this increased blood flow can cause damage to the blood vessels in your lungs.

Problems with large ASD’s are:

Enlargement of the right side of the heart can cause heart failure if left untreated for an extended period.

At least 50% of adults over 40 with ASD have arrhythmia, such as atrial fibrillation or flutter.

Stroke: Pediatric strokes are relatively rare compared to strokes in adults, but they can still occur in infants, children, and adolescents.

Pulmonary Hypertension: This condition is characterized by high blood pressure in the arteries that supply blood to the lungs.

Eisenmenger syndrome can occur in people with an ASD and severe pulmonary hypertension.

What are the symptoms of an Atrial Septal Defect (ASD) in Children in Nigeria?

Usually, babies born with atrial septal defects (ASDs) do not show signs or symptoms. When signs and symptoms do appear, a heart murmur is a very common one. Other symptoms include;

·                Overall Fatigue (tiredness)

·                Shortness of breath while walking

·                A collection of blood and fluid in the lungs

·                The presence of accumulated fluid in the feet, ankles, and legs

·                Being underweight compared to peers

·                Recurrent mild and severe respiratory infections

How are Atrial Septal Defects (ASD) diagnosed in Abuja?

A physical examination is done to check the heart’s structure and function. Additionally, some series of tests are conducted. These tests to diagnose atrial septal defects include:

An electrocardiogram (ECG/EKG) is a test that records the electrical activity of the heart. It can detect heart rhythm abnormalities and problems with the heart's electrical system.

Chest X-Ray: This test will show if your right atrium and right ventricle are enlarged. It’ll also show if the blood vessels in your lungs are affected.

Transthoracic echocardiography (TTE): This test shows how the left-to-right shunting of blood (caused by ASD) affects your heart. It can also display information regarding pulmonary hypertension.

Transesophageal echocardiography (TEE): A transesophageal echocardiogram (TEE) is an ultrasound that examines the size, shape, and location of an ASD and checks heart valves. It is commonly used during ASD surgery and percutaneous repair.

Intracardiac echocardiography (ICE): This is an ultrasound taken inside your heart. A tiny camera (echo probe) is sent to your heart through a peripheral vein. This test shows the size and shape of the ASD and the direction of the blood flow across it. It’s often used during percutaneous (nonsurgical) repair of ASD.

How is Atrial Septal Defect (ASD) treated in Lagos?

Regular checkups are necessary to monitor the closure of an Atrial Septal Defect (ASD). The treatment options for ASDs depend on the severity and size of the defect, as well as the patient's overall health and age.

1.             Watchful waiting: For smaller ASDs that cause no symptoms or only mild symptoms, a wait-and-see approach may be appropriate. In these cases, regular check-ups with a cardiologist can monitor the defect and ensure it is not getting worse.

2.             Medications: In some cases, medications may be prescribed to manage symptoms such as fatigue, shortness of breath, or rapid heartbeat.

3.             Catheter-based closure: This is a minimally invasive procedure that uses a catheter to close the defect. A small device is inserted through a vein in the leg and guided to the heart to seal the ASD.

4.             Open-heart surgery: For larger or more complex ASDs, open-heart surgery may be necessary. During this procedure, the surgeon will make an incision in the chest and repair the defect directly.

Open-Heart Pediatric Surgery in Nigeria

Open-heart surgery generally is performed to repair primum or sinus venosus ASDs by top pediatric cardiac surgeons in Lagos. This procedure is performed under general anesthesia and typically takes 2 to 4 hours to complete. During the surgery, a large incision is made in the chest, and the heart is temporarily stopped to allow the surgeon to access the septum and repair the hole.

What happens during open heart surgery in Nigeria

The specific method to repair atrial septal defects during open heart surgery depends on the size and location of the hole. For small defects, the surgeon may simply sew the hole closed. For larger defects, a patch may be used to cover the hole. After the repair is complete, the heart is restarted and the incision is closed.

What is the recovery process After Atrial Septal Defects (ASD) surgery?

The outlook for children after ASD procedure is excellent. Typically, children spend 3 to 4 days in the hospital before going home. Complications, such as bleeding and infection, from ASD surgery are very uncommon.

Some children may notice inflammation of the outer lining of the heart, a condition called pericarditis (PER-i-kar-DI-tis). This leads to fluid collection around the heart in the weeks after surgery. This complication of heart surgery normally resolves with medicine.

While your child is in the hospital, they will receive necessary medications to reduce pain and anxiety. The doctors and nurses will also educate you on how to care for your child once they are discharged.

Frequently Asked Questions (FAQs) about Arterial Septal Defects (ASD) in Nigeria 

Q: How can Atrial Septal Defects (ASD) be prevented?

A: Top cardiologists in Nigeria suggest that atrial septal defects are congenital heart conditions, meaning they are present at birth and cannot be prevented.

Q: Is Atrial Septal Defect or ASD a commonly prevalent heart condition in Nigeria?

A: ASD is among the most common congenital heart defects in Globally, including in Nigeria.

Q: Is Atrial Septal Defect (ASD) Treatment always necessary?

A: The best pediatric cardiologists in Lagos suggest that the necessity of treatment for ASD depends on the size of the defect and the presence of symptoms. Moderate to large defects or those causing symptoms often require surgical intervention.

Q: Is Atrial Septal Defect (ASD) treatment safe in Nigeria?

A: Top cardiac centers in Lagos and the best cardiac centres in Abuja frequently do Atrial septal defect treatment, typically through cardiac catheterization or open-heart surgery, is well-established and considered safe when performed by experienced pediatric or adult cardiac surgeons in Nigeria.

Q: Which are the best pediatric cardiac hospitals available in Lagos to treat Arterial Septal Defects (ASD)?

A: Center like Evercare, Euracare, First Cardiology clinic and Tristate are some center which does these surgeries. To book an appointment please get in touch with our customer service team.

Q: Which are the best pediatric cardiac hospitals available in Abuja to treat Arterial Septal Defects (ASD)?

A: Some centers like Cardiocare, The Heart Clinic, Foxglove etc. attempt occasionally these surgeries in Abuja. Please get in touch with our team to have more information on these surgeries in Abuja.

Q: Which are the best pediatric cardiac hospitals available in Portharcourt to treat Arterial Septal Defects (ASD)?

A: There are no private pediatric cardiac hospitals available in Portharcourt to treat Arterial Septal defects. However, patients can visit nearby Lagos or Abuja to get themselves treated.

Q: Which are the best pediatric cardiac hospitals available in Kano to treat Arterial Septal Defects (ASD)?

A: There are no private pediatric cardiac hospitals available in Kano to treat Arterial Septal defects. However, patients can visit nearby Abuja to get themselves treated.

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References

https://www.cdc.gov/ncbddd/heartdefects/atrialseptaldefect.html

https://www.nhlbi.nih.gov/health/congenital-heart-defects

https://my.clevelandclinic.org/health/diseases/11622-atrial-septal-defect-asd

https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/atrial-septal-defect-asd

https://www.ncbi.nlm.nih.gov/books/NBK535440/

 

Disclaimer: The information presented here is intended for general patient awareness and should not be relied upon in cases of medical emergencies, diagnosis, or treatment.

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