From the Guidelines
An 8-year-old child undergoing dental surgery with a history of atrial septal defect (ASD) repair should have an EKG as part of their pre-operative evaluation to assess current cardiac function and rhythm. This recommendation is based on the importance of obtaining an ECG at baseline for comparison to any subsequently obtained ECG, as stated in the 2019 AHA/ACC guideline for the management of adults with congenital heart disease 1. The guideline emphasizes that an abnormal baseline ECG is expected in many forms of CHD, particularly those who have undergone surgical repair. Additionally, asymptomatic arrhythmias seen in patients with ACHD may be associated with development of symptoms and increased risk of death, and are more common in particular lesions or repairs, as noted in the 2019 AHA/ACC guideline 1. Key points to consider in the pre-operative evaluation of this child include:
- Fasting guidelines of no solid food for 6-8 hours before surgery and clear liquids allowed up to 2 hours prior
- Continuing any routine cardiac medications as directed by their cardiologist, with only small sips of water if needed on the day of surgery
- Providing the dental surgeon with a complete medical history, including details of the ASD repair, any current medications, and previous anesthesia experiences
- Considering antibiotic prophylaxis depending on the specific cardiac condition and time since repair, typically amoxicillin 50 mg/kg orally one hour before the procedure for children without penicillin allergies
- Consulting with the child's cardiologist to determine if any additional cardiac evaluation beyond an EKG is necessary based on the specific details of the child's cardiac history. It is essential to prioritize the child's cardiac health and take a cautious approach to minimize potential risks associated with the dental surgery.
From the Research
Pre-operative Recommendations for Dental Surgery in Children
- The American Heart Association recommends that children with certain heart conditions, including those with a history of atrial septal defect (ASD) repair, may require special consideration before undergoing dental surgery 2.
- However, there is no specific guideline for an 8-year-old child who has had an ASD repair to undergo an EKG before dental surgery.
- A study on preoperative assessment for children requiring dental treatment under general anesthesia found that a history of cardiac anomalies, including ASD, had a strong association with changes in medical management prior to surgery 3.
Considerations for Children with ASD Repair
- Children with a history of ASD repair may be at a higher risk for infective endocarditis, and therefore may require antibiotic prophylaxis before dental surgery 2, 4.
- However, the decision to perform an EKG or other pre-operative tests should be made on a case-by-case basis, taking into account the individual child's medical history and current health status.
- There is no direct evidence to suggest that an EKG is necessary for an 8-year-old child who has had an ASD repair before undergoing dental surgery.
Dental Surgery and ASD
- A study on the retrieval and repositioning of an embolized ASD closure device found that children with ASD can undergo successful device closure with minimal complications 5.
- However, this study does not provide guidance on pre-operative recommendations for dental surgery in children with ASD repair.
- Another study on addressing dental fear in children with autism spectrum disorders found that electronic screen media can be a useful tool in reducing fear and uncooperative behaviors during dental visits, but this study does not address the specific needs of children with ASD repair 6.