Commonly Asked Questions

An atrial septal defect (ASD) is the name given to a hole in the atrial septum or muscle wall that separates the left and right atria, or chambers of the heart. Because of the lower pressure in the right atrium, this hole typically allows oxygenated blood from the lungs to move, or shunt, from the left into the right atrium. This blood proceeds into the right ventricle, which pumps it back to the lungs rather than to the body.
Children with atrial septal defects (ASD) are usually slender in build and have a heart murmur caused by the extra blood flow due to the defect. They may experience shortness of breath or heart palpitations. However, they can be normally active, show no other outward symptoms, and aren't restricted from exercise. 

However the larger the defect, the more children are likely to have symptoms. Infants with a large ASD may develop congestive heart failure. But a defect smaller than 2 millimeters has a high probability that it will close on its own. Surgery isn't usually performed in these cases. 

Larger ASDs which may not close cause excessive blood flow, which can increase the size of the right atrium, and cause high pressures that may distort the shape of the pulmonary artery. An enlarged right atrium can result in abnormal heart rhythms and the effects cannot be reversed by closing the ASD. Untreated ASD can result in heart failure in young adulthood.
ASDs may be closed surgically or less invasively by use of catheters. 

Surgically, an ASD may be closed by patching or suturing the defect during open heart surgery. Patches are made of silk, Dacron, Teflon, or pericardium (the membrane covering the heart). Sutures are monofilament thread made of Prolene or Polyproplyene. 

Alternatively, after the size of the ASD has been determined, a septal occluder is introduced into the ASD to close the hole with a less invasive catheter. The catheter enters form the groin or the forearm, and continues into the heart.
Women with atrial septal defects (ASDs) are usually able to bear children without difficulty, however anyone with congenital heart disease, repaired or non-repaired, should consult with their cardiologist and review the risks before trying to get pregnant. 

It is common for ASDs to be first diagnosed during pregnancy because of the development of heart murmurs and other breathing issues. It is better to repair ASDs before pregnancy to avoid complications caused by blood clots, which may cause strokes or heart failure.
Normal physical activity is okay after repairing of an atrial septal defect (ASD) as long as pulmonary and artery blood pressure remains acceptably low. However restrictions will be necessary if the right ventricle is significantly enlarged, if there is pulmonary hypertension, or untreated arrhythmia. 

If you have had an ASD repaired or have congenital heart disease (repaired or non-repaired), it is best to consult with a cardiologist to review risks before beginning an exercise program.
As the term might suggest, minimally-invasive cardiac surgery has many advantages over the standard approach of a sternotomy where the entire breastbone is split. 

There is reduced trauma to chest wall tissues, smaller incisions and smaller scars. There is also reduced infection risk, less blood loss, and less pain. In addition the hospital stay is shorter – three to five days versus five to seven days for traditional sternotomy-based cardiac operations. 

Last but not least, because the procedure is less invasive, you will recover in two to four weeks and have fewer physical restrictions. Recovering from a sternotomy-based cardiac operation usually takes six to eight weeks. In general, patients are restricted from driving from four to six weeks or lifting anything heavier than 5 to 10 pounds for eight to twelve weeks after surgery.
The aortic valve is located in the heart (between the left ventricle and aorta) and is responsible for allowing blood to flow from the left ventricle into the aorta. The left ventricle is the main pumping chamber in the heart, and the aorta (the largest artery) is responsible for sending oxygenated blood throughout the body. 

When the left ventricle squeezes blood into the aorta, the aortic valve normally closes to prevent blood from flowing back into the left ventricle.
The aortic valve is located in the heart (between the left ventricle and aorta) and is responsible for allowing blood to flow from the left ventricle into the aorta. The left ventricle is the main pumping chamber in the heart, and the aorta (the largest artery) is responsible for sending oxygenated blood throughout the body.

When the left ventricle squeezes blood into the aorta, the aortic valve normally closes to prevent blood from flowing back into the left ventricle. When the aortic valve doesn't close efficiently, it can allow blood to leak backwards into the heart – a condition known as aortic regurgitation or aortic insufficiency

Naturally, blood leaking back into the heart means less is going out to the body – so it needs to works harder to provide an adequate supply of oxygenated blood. Common symptoms of aortic regurgitation include shortness of breath, decreased endurance during exercise, and swelling in the extremities. 

Aortic regurgitation can be caused by congenital malformations (birth defects), infection, aortic aneurysms, or acquired diseases such as rheumatic heart disease.
The aortic valve is located in the heart (between the left ventricle and aorta) and is responsible for allowing blood to flow from the left ventricle into the aorta. The aortic valve contains three leaflets, and should these leaflets become abnormally rigid (a condition known as aortic stenosis) they do not open fully – which causes the valve to narrow, making it harder for blood to move from the heart to the rest of the body. 

Aortic stenosis is most commonly caused by calcium buildup on the leaflets of the aortic valve – which tends to occur as people get older. The other cause stems from birth defects during which two leaflets are fused into one – meaning the “tricuspid” aortic valve becomes a “bicuspid” aortic valve.
Aortic regurgitation (or insufficiency), is a condition when the aortic valve – a one-way valve that transmits blood from the heart to the aorta,– doesn't close efficiently, allowing blood to leak backwards into the heart. 

The severity of aortic insufficiency can sometimes be reduced with medications. The most definitive treatment involves surgical replacement of the defective valve with a prosthetic one. Not all aortic regurgitation needs to be treated surgically. Only the most severe regurgitation that causes symptoms requires surgery.
The aortic valve is located in the heart (between the left ventricle and aorta) and is responsible for allowing blood to flow from the left ventricle into the aorta. The aortic valve contains three leaflets, and should these leaflets become abnormally rigid (a condition known as aortic stenosis) they do not open fully – which causes the valve to narrow, making it harder for blood to move from the heart to the rest of the body. 

Aortic stenosis is most commonly caused by calcium buildup on the leaflets of the aortic valve – which tends to occur as people get older. The other cause stems from birth defects during which two leaflets are fused into one – meaning the “tricuspid” aortic valve becomes a “bicuspid” aortic valve.

Unfortunately, there is no effective medical therapy for aortic stenosis at this time. After being diagnosed with aortic stenosis, it is important to receive this surgery in a timely fashion – a significant delay may lead to irreversible congestive heart failure. Only severe aortic stenosis the causes symptoms requires surgery.
The aortic valve is located in the heart (between the left ventricle and aorta) and is responsible for allowing blood to flow from the left ventricle into the aorta. When it is damaged or functioning poorly, the surrounding tissue must be repaired, or the valve itself must be replaced surgically. 

Aortic valve replacements require the use of cardiopulmonary bypass, otherwise known as “the heart-lung machine.” This machine permits the surgeon to safely open the aorta and access the valve. In most cases, the heart is also stopped for about an hour. 

The operation involves opening of the aorta and removal of the diseased aortic valve leaflets. After the physician measures the valve ring and determines the correct size of the replacement, the valve is lowered into place, the aorta is closed, and the heart is restarted.

The entire operation takes about two or three hours to complete.
There are two major types of aortic valve prostheses – mechanical and tissue. 

Mechanical replacement valves have lifelong durability, however a blood thinning drug must be taken for the rest of the patient’s life to prevent blood clots from forming on the hinges of the valve. Besides being somewhat of a nuisance, taking blood thinners also create a small risk of bleeding complications. 

Tissue or “bioprosthetic” valves are made of cow or pig tissue. Because they are made of natural materials, there isn’t a need to take blood thinners. However they are less durable, lasting about 10-15 years. 

Your doctor will help you make a decision on which kind of aortic valve replacement to pick based on your age, occupation, lifestyle, medical history, and preference.
An atrial septal defect or ASD is an opening between the upper two chambers of the heart, known as the right atrium and the left atrium. A congenital heart defect, an ASD permits mixing of deoxygenated blood returning to the heart from the body (right atrium) and freshly oxygenated blood coming from the lungs (left atrium). 

The degree of mixing is largely related to the size of the defect and the relative pressures in each atrium. After birth, , blood from the left atrium preferentially moves into the right atrium, causing excessive blood to flow through the lungs. If this flow (known as shunting) is significant enough, resistance develops in the lung, resulting in a gradual reversal of shunting of deoxygenated blood from the right atrium into the left atrium and then throughout the body. 

This latter condition can lead to a condition called “cyanosis” whereby inadequately oxygenated blood is delivered to the body causing early fatigue and congestive heart failure.
An atrial septal defect (ASD) is an opening between the upper two chambers of the heart. 

After birth, an ASD causes blood from the left atrium to move into the right atrium, causing excessive blood to flow through the lungs. If this flow, otherwise known as “shunting” is significant enough, resistance to flow develops in the lung. This results in a gradual reversal of deoxygenated blood from the right to the left atrium, and subsequently through the body. This further causes cyanosis, where the body doesn't get properly oxygenated blood. The result is early fatigue and congestive heart failure.
An atrial septal defect (ASD), a congenital defect, is an opening between two chambers (atria) of your heart. They can cause “shunting” – excessive flow of blood through the lungs. In turn, this can cause cyanosis, where inadequately oxygenated blood can cause early fatigue and subsequently, congestive heart failure. 

Small ASDs can often be followed without surgery if they cause minimal shunting. Larger ASDs are closed surgically by simply sewing them closed, or placing a patch of your own tissue or a synthetic material (such as Dacron) over it. They can also be fixed in the cardiac catheterization laboratory using a Dacron patch.
An atrial septal defect (ASD) is a congenital defect where there is an opening in the wall between chambers (atria) of the heart. ASD is repaired surgically with the use of the cardiopulmonary bypass, or heart-lung machine, which allows the surgeon to safely open up the right chamber of your heart and access the defect in a relatively bloodless field. Your heart might also be stopped for up to two hours to help the surgery occur. 

Repairing your ASD can range from a relatively simple operation to a more complex one depending on the location, size, and characteristics of the defect. 

The total operation time of an ASD repair ranges from two to three hours.
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 two minimally-invasive alternatives – a mini-ASD repair and a robotic ASD repair. 

A mini-ASD repair uses a “mini-thoracotomy” which consists of a three-inch incision made through the right side of your chest between your ribs. The heart-lung bypass, required to stop your heart long enough for the surgeon to close the defect, is instituted with small tubes placed in the main artery and vein of your right leg through a one to two inch incision placed in the right groin crease. Your heart will then be stopped and the right atrium opened to expose the ASD. At this point, the surgeon will insert specialized hand-held “chopstick” like instruments through the incision to repair the defect. Once the defect is repaired, your heart will be closed and restarted. You will be disconnected from the heart-lung bypass and the incision will be closed. 

In a robotic-ASD repair, the surgeon uses a surgical robotic system instead of hand-operated instruments. The da Vinci robotic system is currently the most technologically advanced surgical robotic system in the world. It is designed to perform complex operation through incisions that are much smaller and less traumatic than those used with traditional surgical approaches. 

The da Vinci robotic system has four parts – a console for the surgeon, a computerized control system, two “arms,” and a fiber optic camera. The surgeon sits at the console and views the heart in magnified, highly detailed, full colored, three-dimensional images through the camera while manipulating the arms. The computers and robot mimic the surgeon's hand motions and allows the fine tips of the robot's arms to perform delicate surgery in small incisions.
An atrial septal defect (ASD) is a congenital defect where there is an opening in the wall between chambers (atria) of the heart. The most common surgical approach requires the surgeon to open the breastbone and spread the edges for direct access to the heart. Mini-ASD is one of two minimally-invasive alternatives available (the other being Robotic-ASD). 

A mini-ASD repair uses a “mini-thoracotomy” which consists of a three-inch incision made through the right side of the chest, between your ribs. The heart-lung bypass, required to stop your heart long enough for the surgeon to close the defect, is instituted with small tubes placed in the main artery and vein of your right leg through a one to two inch incision placed in the right groin crease. Your heart will then be stopped and the right atrium opened to expose the ASD. At this point, the surgeon will insert specialized hand-held “chopstick” like instruments through the incision to repair the defect. Once the defect is repaired, your heart will be closed and restarted. You will be disconnected from the heart-lung bypass and the incision will be closed.
An atrial septal defect (ASD) is a congenital defect where there is an opening in the wall between chambers (atria) of the heart. The most common surgical approach requires the surgeon to open the breastbone and spread the edges for direct access to the heart. Robotic-ASD is one of two minimally-invasive alternatives available (the other being a mini-ASD).

In a robotic-ASD repair, the surgeon uses a surgical robotic system instead of hand-operated instruments. The da Vinci robotic system is currently the most technologically advanced surgical robotic system in the world. It is designed to perform complex operation through incisions that are much smaller and less traumatic than those used with traditional surgical approaches. 

The da Vinci robotic system has four parts – a console for the surgeon, a computerized control system, two “arms,” and a fiber optic camera. The surgeon sits at the console and views the heart in magnified, highly detailed, full colored, three-dimensional images through the camera while manipulating the arms. The computers and robot mimic the surgeon's hand motions and allows the fine tips of the robot's arms to perform delicate surgery in small incisions.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow through the left side of the heart. When open, the mitral valve allows oxygenated blood from the lungs to fill the heart's main pumping chamber, the left ventricle. When the left ventricle squeezes to deliver blood throughout the body, the mitral valve normally closes to prevent blood from flowing back toward the lungs.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow through the left side of the heart. When open, the mitral valve allows oxygenated blood from the lungs to fill the heart's main pumping chamber, the left ventricle. When the left ventricle squeezes to deliver blood throughout the body, the mitral valve normally closes to prevent blood from flowing back toward the lungs. 

Mitral regurgitation, also called insufficiency, is a condition when the mitral valve malfunctions and permits blood from the left ventricle to leak backwards towards the lungs. 

This condition is caused most often by congenital malformations (birth defects), or damage due to trauma, infection, or heart failure. Depending on the severity of the leakage, mitral regurgitation can lead to progressive lung congestion and heart failure.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow from the lung through the left side of the heart. Mitral regurgitation, also called insufficiency, is a condition when the mitral valve malfunctions and permits blood from the left ventricle to leak backwards towards the lungs.

Treatment of mitral regurgitation depends on the severity of the case. It can sometimes be reduced with medications, but surgical repair or replacement with a prosthetic valve remains the definitive course of action. 

In many cases, the mitral valve can be repaired by reconstructing the native valve tissues to restore normal structure and function. In fact, the mitral valve is the most commonly repaired heart valve.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart. In fact, the mitral valve is the most commonly repaired heart valve.

A faulty mitral valve can be repaired or replaced. Experimental and clinical research has shown that repair of the mitral valve is the first and better option than replacement – largely because the native mitral valve is so closely associated with the structure of the left ventricle. If the mitral valve cannot be repaired, replacement is the second option. Replacing the mitral valve involves removing much of the native mitral valve tissues and replacing it with an artificial valve consisting of animal or manufactured components.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart. Mitral valve prolapse is one of the most common diseases to affect the mitral valve. In this condition, one or more of the leaflets swings too far backward into the left atrium during eachcontraction of the left ventricle, so that the leaflets do not close properly, allowing blood to leak between them.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart. Mitral valve prolapse is one of the most common diseases to affect the mitral valve. In this condition, one or more of the leaflets swings too far backward into the left atrium during each contraction of the left ventricle, so that the leaflets do not close properly, allowing blood to leak between them.

To fix a mitral valve prolapse, a surgeon will remove extra leaflet tissue, fuse the prolapsing leaflets together, replace the valve suspension mechanism, and put a prosthetic strut around the valve.

The repairs require the use of a cardiopulmonary bypass or heart-lung machine, which allows the surgeon safe access to the mitral valve in a bloodless field. The heart is stopped for one to two hours to make the repair possible. Mitral valve prolapse repair can range from relatively simple to very complex and intricate procedures. The operation runs about three to five hours.

Although most mitral valves can be repaired some can't, and have to be replaced with a prosthetic valve. Most mitral valve repairs are quite durable—about 10 to 15 percent of patients who have repairs require a re-operation later for a failed repair.
Mitral valves are better repaired than replaced for several reasons, not the least of which is location. The mitral valve—a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart—is s closely associated with its location in the heart. So repairing it preserves the natural geometry and attachments of the left ventricle which permits it to function efficiently. This is very important in patients who have abnormal heart function.

Also, a mechanical replacement requires patients to take a blood thinner such as coumadin or warfarin for the rest of their lives so as to prevent blood clots around the replacement. In addition to being a nuisance, this also creates a small risk of bleeding complications.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart. In fact, the mitral valve is the most commonly repaired heart valve. However the most common surgical approach to the mitral valve is to have the surgeon saw open the breastbone and spread the edges to gain direct access to the heart.

Mini-mitral repair is one of two minimally-invasive alternatives available (the other being robotic mitral repair). 

A mini-mitral repair uses a “mini-thoracotomy” which consists of a three-inch incision made through the right side of your chest between your ribs. The heart-lung bypass, required to stop your heart long enough for the surgeon to close the defect, is instituted with small tubes placed in the main artery and vein of your right leg through a one to two inch incision placed in the right groin crease. Your heart will then be stopped and the right atrium opened to expose the ASD. At this point, the surgeon will insert specialized hand-held “chopstick” like instruments through the incision to repair the defect. Once the defect is repaired, your heart will be closed and restarted. You will be disconnected from the heart-lung bypass and the incision will be closed.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow from the lung through the left ventricle of the heart. In fact, the mitral valve is the most commonly repaired heart valve. However the most common surgical approach to the mitral valve is to have the surgeon saw open the breastbone and spread the edges to gain direct access to the heart. 

Robotic mitral repair is one of two minimally-invasive alternatives available (the other being mini-mitral repair).

In a robotic mitral repair, the surgeon uses a surgical robotic system instead of hand-operated instruments. The robotic system is designed to perform complex operation through incisions that are much smaller and less traumatic than those used with traditional surgical approaches.

The robotic system has four parts – a console for the surgeon, a computerized control system, two “arms” and a fiber optic camera. The surgeon sits at the console and views the heart in magnified, highly detailed, full colored, three-dimensional images through the camera while manipulating the arms. The computers and robot mimic the surgeon's hand motions and allows the fine tips of the robot's arms to perform delicate surgery in small incisions.
Classified as an ablation procedure, Mini-maze procedures involve using hot or cold energy sent through a catheter to destroy malfunctioning tissue. Traditional sternotomies open up the chest and require sawing open the breastbone to access the heart. In contrast, Mini-maze procedures use small incisions made between the ribs on each side of the chest and don't require a heart-lung bypass machine – meaning the procedure is performed on a beating heart. It also means that mini-maze postoperative stays are relatively short, averaging three to four days. 

The mini-maze operation itself usually takes no more than three to four hours. A success rate of 80 percent has been observed in Mini-Maze procedures. As with catheter-based interventions, the Mini-Maze procedures are likely to be more successful if you are a patient with recent arrhythmia (abnormal and/or irregular heart beat) rather than a life long history of the problem.
Classified as an ablation procedure, Mini-maze procedures involve using hot or cold energy sent through a catheter to destroy malfunctioning tissue. Traditional sternotomies open up the chest and require sawing open the breastbone to access the heart. In contrast, Mini-maze procedures use small incisions made between the ribs on each side of the chest and don't require a heart-lung bypass machine – meaning the procedure is performed on a beating heart. It also means that mini-maze postoperative stays are relatively short, averaging three to four days.

However, precautions still need to be taken after a mini-maze procedure. It can often take several months for the procedure to take full effect, so if you have a Mini-Maze procedure, you will be placed on a short course of anti-arrhythmic drugs and a blood thinner. You should be able to resume normal activity, including work, in about two to four weeks after surgery.
The surgical robotic system, used for minimally-invasive surgical operations. It was first used in June 2003 on a beating heart by Drs. David Yuh and William Baumgartner at Johns Hopkins Hospital.

The surgical robotic system is comprised of four things:

  • Surgeon console 
  • Computerized control system 
  • Two instrument “arms” 
  • Fiberoptic camera 
The robot is designed to perform complex operations through incisions that are much smaller and less traumatic than those used with traditional surgical approaches. 

Traditional approaches, such as sternotomies, are performed with a large incision down the center of the breastbone, which then has to be sawed open for access to the heart. With a da Vinci surgery, there is a much smaller incision, less scarring, less pain, fewer wound complications, a shorter hospital stay, and a shorter recovery time.
The surgical robotic system, used for minimally-invasive cardiac surgical operations. It is designed to perform complex operations through incisions that are much smaller and less traumatic than those used with traditional surgical approaches. Traditional approaches, such as sternotomies, are performed with a large incision down the center of the breastbone, which then has to be sawed open for access to the heart. With a robotic surgery, there is a much smaller incision, less scarring, less pain, fewer wound complications, a shorter hospital stay, and a shorter recovery time.

The surgical robotic system is comprised of four different parts:

  • Surgeon console 
  • Computerized control system 
  • Two instrument “arms” 
  • Fiberoptic camera 
Instead of using hand-operated instruments, the surgeon sits at the console and views the heart in magnified, highly detailed, full colored, three-dimensional images through the camera while manipulating the arms. The computers and robot mimic the surgeon's hand motions and allows the fine tips of the robot's arms to perform delicate surgery in small one-centimeter port incisions.
The mitral valve is a one-way valve made up of two leaflets that conducts blood flow through the left side of the heart. When open, the mitral valve allows oxygenated blood from the lungs to fill the heart's main pumping chamber, the left ventricle. When the left ventricle squeezes to deliver blood throughout the body, the mitral valve normally closes to prevent blood from flowing back toward the lungs. A defective mitral valve can lead to lung congestion and heart failure.

The surgical robotic system can now be used to fix mitral valves at Johns Hopkins Hospital. In fact it is one of the first cardiac surgical operations to have been performed with the da Vinci system and for which U.S. Food and Drug Administration (FDA) approval was obtained. The procedure was pioneered in Europe and further refined in the U.S.

A defective mitral valve can be reached by the da Vinci system through a small six to eight-centimeter thoracatomy (an incision in the chest) and two one-centimeter instrument ports. The da Vinci system gives the surgeon a superior view of the area that needs to be repaired, making the surgery easier.
The surgical robotic system isused for minimally-invasive cardiac surgical operations. It was first used by Drs. David Yuh and William Baumgartner at Johns Hopkins Hospital in June 2003 on a beating heart. 

The surgical robotic system is comprised of four parts:

  • Surgeon console
  • Computerized control system 
  • Two instrument “arms” 
  • Fiberoptic camera 
It is designed to perform complex operations through incisions that are much smaller and less traumatic than those used with traditional surgical approaches. Traditional approaches, such as sternotomies, are performed with a large incision down the center of the breastbone, which then has to be sawed open for access to the heart. With a robotic procedure, there is a much smaller incision, less scarring, less pain, fewer wound complications, a shorter hospital stay, and a shorter recovery time. 

Dr. Yuh is now collaborating with Dr. Okamura of the Johns Hopkins Department of Mechanical Engineering to develop robotic sensory feedback for the da Vinci robotic surgical system. The idea is that a “sense of touch” would help cardiac surgeons to perform delicate operations more safely and efficiently with the robotic system. Dr. Yuh is also developing methods for training physicians and residents in the use of the robotic system using mathematical modeling. The hope is that mathematical modeling will ultimately lead to improved surgical training techniques and better-trained robotic surgeons.