Several weeks before surgery, the patient may be required to undergo a test called a transesophageal echocardiogram (TEE) to find the diseased area in the septum. To perform this test, the physician inserts a thin tube (endoscope) into the patient’s esophagus (the long tube that connects the throat with the stomach), which ends just behind the patient’s heart. At the far end of the endoscope is a small device called a transducer, which sends and receives high-frequency sound waves (ultrasound signals). A computer near the operating table then calculates the travel time of these sound waves to and from the heart, thereby constructing a very clear and virtually unobstructed image of the heart’s size and function. This may be recorded on video monitors, paper (still pictures) and/or videotape.

A few days before surgery, the patient will undergo a number of tests. Even if these tests were performed days or weeks earlier, they will be done again just before surgery to be sure that the patient’s medical condition has not changed. They include:

Eight to twelve hours before surgery, all patients are placed on NPO (non per os; nothing by mouth) status. That means that they are not permitted to eat, drink or take anything by mouth until after their surgery. Smokers will have been advised to completely avoid smoking for at least two weeks before their surgery to prevent problems in blood flow, clotting or breathing. Certain medications may need to be reduced or stopped temporarily, so patients should discuss their medication schedules with their cardiologist before surgery.

The patient is usually admitted the morning of surgery. He or she will be given specific pre-operative medications and then “prepped” for surgery. The chest is shaved, and a bacteria-killing (bactericidal) solution is applied to the operative site and surrounding area. The patient is then put to sleep with a medication that is given through an intravenous (IV) line in the arm or hand. The patient will continue to breathe a mixture of oxygen and anesthetic gas (general anesthesia) to make sure that he or she remains asleep throughout the entire surgery.