Explain an atrial septal defect diagnosis to parents and plan the closure — OSCE

Communication framework

Establish what the parents already understand and fear. Ask them to recount what they have been told and what they have read online, and acknowledge their fear directly. Do not correct them before you have heard them; the fear of open heart surgery and a limited life are the ones you will spend the most time addressing, and you address them with the evidence that most secundum defects are closed with a keyhole device and that the outlook is excellent. ^[5]

Explain the atrial septal defect in plain language. The heart has four chambers, and between the two top chambers there is a wall called the atrial septum. Your daughter was born with a small hole in that wall, called an atrial septal defect. Because the pressure is slightly higher on the left side, a bit of extra blood flows from left to right through the hole, and that extra blood makes the right side of the heart work a little harder than it should. The sound the doctor heard — the murmur — is the sound of that extra blood flow. ^[5]

Reassure on cause and guilt. This is not caused by anything you did or did not do. It is a congenital condition, meaning your daughter was born with it, and it is one of the commonest heart conditions we find in children. You did not cause it, and you could not have prevented it. The reason we are finding it now is good news, because we have the chance to fix it before it causes any problems. ^[5]