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The symptoms of an atrial septal defect may resemble other medical conditions or heart problems. Always consult your
child's physician for a diagnosis.
chest X-ray - a diagnostic test which uses invisible X-ray beams to produce images of internal tissues, bones, and
organs onto film. With an ASD, the heart may be enlarged because the right atrium and ventricle have to handle
larger amounts of blood flow than normal. Also, there may be changes that take place in the lungs due to extra
blood flow that can be seen on an X-ray.
electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms
(arrhythmias or dysrhythmias), and detects heart muscle stress.
echocardiogram (echo) - a procedure that evaluates the structure and function of the heart by using sound waves
recorded on an electronic sensor that produce a moving picture of the heart and heart valves. An echo can show the
pattern of blood flow through the atrial septal opening, and determine how large the opening is, as well as how
much blood is passing through it.
cardiac catheterization - a cardiac catheterization is an invasive procedure that gives very detailed information
about the structures inside the heart. Under sedation, a small, thin, flexible tube (catheter) is inserted into a blood
vessel in the groin, and guided to the inside of the heart. Blood pressure and oxygen measurements are taken in the
four chambers of the heart, as well as the pulmonary artery and aorta. Contrast dye is also injected to more clearly
visualize the structures inside the heart. Although an echocardiogram often provides enough diagnostic
information, device closure of the ASD can be performed at the time of the catheterization.
Secundum atrial septal defects may close spontaneously as a child grows. Once an atrial septal defect is diagnosed, your
child's cardiologist will evaluate your child periodically to see whether it is closing on its own. Usually, an ASD will be
repaired if it has not closed on its own by the time your child starts school - to prevent lung problems that will develop from
long-time exposure to extra blood flow. The decision to close the ASD may also depend on the size of the defect. Individuals
who have their atrial septal defects repaired in childhood can prevent problems later in life.
medical management
Many children have no symptoms, and require no medications. However, some children may need to take
medications to help the heart work better, since the right side is under strain from the extra blood passing through
the ASD. Medications that may be prescribed include the following:
o digoxin - a medication that helps strengthen the heart muscle, enabling it to pump more efficiently.
o diuretics - the body's water balance can be affected when the heart is not working as well as it could.
These medications help the kidneys remove excess fluid from the body.
infection control
Children with certain heart defects are at risk for developing an infection of the inner surfaces of the heart known
as bacterial endocarditis. It is important that you inform all medical personnel that your child has an ASD so they
may determine if the antibiotics are necessary before a procedure.
surgical repair
Your child's ASD may be repaired surgically in the operating room. The surgical repair is performed under general
anesthesia. The defect may be closed with stitches or a special patch.
device closure
Device closure is frequently performed for secundum ASD, depending on the size of the defect and the weight of
the child. During the cardiac catheterization procedure, the child is sedated and a small, thin, flexible tube
(catheter) is inserted into a blood vessel in the groin and guided to the inside of the heart. Once the catheter is in
the heart, the cardiologist will pass a special device, called a septal occluder, into the open ASD, preventing blood
from flowing through it.
Your child may be able to go home after a specified period of time, providing he/she does not need further
treatment or monitoring. You will receive written instructions regarding care of the catheterization site, bathing,
activity restrictions, and any new medications your child may need to take at home.
surgical repair
In most cases, children will spend time in the intensive care unit (ICU) for several hours, or overnight, after an
ASD repair. During the first several hours after surgery, your child will most likely be drowsy from the anesthesia
that was used during the operation, and from medications given to relax him/her and to help with pain. As time
goes by, your child will become more alert.
While your child is in the ICU, special equipment will be used to help him/her recover, and may include the
following:
o ventilator - a machine that helps your child breathe while he/she is under anesthesia during the operation.
A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your
child while he/she is too sleepy to breathe effectively on his/her own. Many children have the ventilator
tube removed right after surgery, but some other children will benefit from remaining on the ventilator
for a few hours afterwards so they can rest.
o intravenous (IV) catheters - small, plastic tubes inserted through the skin into blood vessels to provide IV
fluids and important medications that help your child recover from the operation.
o arterial line - a specialized IV placed in the wrist, or other area of the body where a pulse can be felt, that
measures blood pressure continuously during surgery and while your child is in the ICU.
o nasogastric (NG) tube - a small, flexible tube that keeps the stomach drained of acid and gas bubbles that
may build up during surgery.
o urinary catheter - a small, flexible tube that allows urine to drain out of the bladder and accurately
measures how much urine the body makes, which helps determine how well the heart is functioning.
After surgery, the heart will be a little weaker than it was before, and, therefore, the body may start to
hold onto fluid, causing swelling and puffiness. Diuretics may be given to help the kidneys remove
excess fluids from the body.
o chest tube - a drainage tube may be inserted to keep the chest free of blood that would otherwise
accumulate after the incision is closed. Bleeding may occur for several hours, or even a few days after
surgery.
o heart monitor - a machine that constantly displays a picture of your child's heart rhythm, and monitors
heart rate, arterial blood pressure, and other values.
Your child may need other equipment, not mentioned here, to provide support while in the ICU, or afterwards. The hospital
staff will explain all of the necessary equipment to you.
Your child will be kept as comfortable as possible with several different medications; some of which relieve pain and some
of which relieve anxiety. The staff may also ask for your input as to how best to soothe and comfort your child.
After discharge from the ICU, your child will recuperate on another hospital unit for a few days before going home. You will
learn how to care for your child at home before your child is discharged. Your child may need to take medications for a while
and these will be explained to you. The staff will provide instructions regarding medications, activity limitations, and followup appointments before your child is discharged.
BAB II
TINJAUAN PUSTAKA
2.1
Definisi
A.
ASD
(Atrium
Septal
Defect)
ASD adalah penyakit jantung bawaan berupa lubang (defek) pada septum interatrial
(sekatantar serambi) yang terjadi karena kegagalan fungsi septum interatrial semasa janin.
Defek Septum Atrium (ASD, Atrial Septal Defect) adalah suatu lubang pada dinding(septum)
yang memisahkan jantung bagian atas (atrium kiri dan atrium kanan). Kelainan jantung ini
mirip seperti VSD, tetapi letak kebocoran di septum antara serambi kiridan kanan. Kelainan
ini
menimbulkan
keluhan
yang
lebih
ringan
dibanding
VSD.
Atrial Septal Defect adalah adanya hubungan (lubang) abnormal pada sekat yang memisahkan
atrium kanan dan atrium kiri. Kelainan jantung bawaan yang memerlukan pembedahan
jantung terbuka adalah defek sekat atrium. Defek sekat atrium adalah hubungan langsung
antara serambi jantung kanan dan kiri melalui sekatnya karena kegagalan pembentukan sekat.
Defek ini dapat berupa defek sinus venousus di dekat muara vena kavasuperior, foramen
ovale terbuka pada umumnya menutup spontan setelah kelahiran, defek septum sekundum
yaitu kegagalan pembentukan septum sekundum dan defek septumprimum adalah kegagalan
penutupan septum primum yang letaknya dekat sekat antar bilik atau pada bantalan endokard.
Macam-macam defek sekat ini harus ditutup dengan tindakan bedah sebelum terjadinya
pembalikan aliran darah melalui pintasan ini dari kanan ke kiri sebagai tanda timbulnya
sindrome Eisenmenger. Bila sudah terjadi pembalikan aliran darah, maka pembedahan
dikontraindikasikan. Tindakan bedah berupa penutupan dengan menjahit langsung dengan
jahitan
jelujur atau
dengan
menambal
defek
dengan sepotong
dakron.
2.2
Klasifikasi
ASD
di
klasifikasikan
menjadi
:
a. ASD sederhana dengan defek pada septum dan sekitar fossa ovalis (dikenal dengan DSA
sekundum), defek pada tepi bawah septum (DSA primum) dan defek sekitar muara VCS
(defek sinus venosus) yang seringkali disertai anomali parsial drainase vena pulmonalis.
b. ASD kompleks yang merupakan bentuk dari defek endocardial cushion yang sekarang
dikenal
sebagai
defek
septum
atrioventikular
(DSAV)
atau
AV canal.
Defek septum atrium sekundum adalah kelainan yang dimana terdapat lubang patologis di
tempat fossa ovalis. Akibatnya terjadi pirau dari atrium kiri ke atrium kanan, dengan beban
volume
di
atrium
dan
ventrikel
kanan.
VSD
di
klasifikasikan
menjadi
:
a. VSD kecil dengan tahanan pada arterior pulmonalis masih normal.
b. VSD sedang dengan tahanan pada arterior pulmonalis masih normal.
c. VSD besar dan sudah disertai hipertensi pulmonal yang dinamis, hipertensi pulmonal
terjadi karena bertambahnya volume darah arterior pulmonalis tetapi belum ada kenaikan
tahanan arterior pulmonalis atau belum ada arteriosklerosis arterior pulmonalis.
2.3
Etiologi
a.
ASD
1.
Faktor
genetik
Resiko penyakit jantung kongenital meningkat 2 sampai 6% jika terdapat riwayat keluarga
yang terkena sebelumnya. Selain itu 5-8% penderita penyakit jantung kongenital mempunyai
keterkaitan
dengan
kelainan
kromosom.
2.
Faktor
lingkungan
Penyakit jantung kongenital juga di hubungkan dengan lingkungan ibu selama kehamilan.
Seringnya terpapar dengan sinar radioaktif dipercaya dapat menjadi faktor pencetus terjadinya
penyakit
jantung
kongenital
pada
bayi.
3.
Obat-obatan
Meliputi obat-obatan yang dikonsumsi ibu selama masa kehamilan, misalnya litium, etanol,
thalidomide,
dan
agen
antikonsulvan.
4.
Kesehatan
ibu
Beberapa penyakit yang di derita oleh ibu hamil dapat berakibat pada janinnya, misalnya
diabetes mellitus, fenilketouria, lupus eritematusus siskemik, sindrome rubella kongenital.