Overview

How is an ASD closed using a catheter-based procedure ?

Catheter-based procedures are commonly used to diagnose and treat heart-related problems. For example, catheter-based procedures are used to diagnose and treat clogged arteries and heart attacks. A catheter can also be used to guide the placement of an ASD device - which becomes a permanent implant - that will close the hole in the heart wall.

To further briefly explain what happens in an ASD catheter-based procedure, a cardiac catheterization involves slowly moving a catheter (a long, thin, flexible, hollow tube) into the heart. The catheter is initially inserted into a large vein through a small incision made usually in the inner thigh (groin area) and then is advanced to and into the heart. One or more tests will be done to measure the ASD and to be sure there are no other defects. An imaging test called angiography, (an injection of a certain type of dye followed by an x-ray motion picture) may be used to better visualize the heart.

An ASD closure device is moved through the catheter to the heart and specifically to the location of the heart wall defect. Once in the correct location, the ASD closure device is allowed to expand its shape to straddle each side of the hole. The device will remain in the heart permanently to stop the abnormal flow of blood between the two atria chambers of the heart. The catheter is then removed and the procedure is complete.

Atrial septal defect , or ASD for short, is a heart condition that can affect kids. To understand an ASD, it helps to know how the heart works. The heart has four chambers. The lower chambers of the heart are called the ventricles. There are two ventricles: a left ventricle and a right ventricle. The upper chambers are the atria and there are two of them — a left atrium and a right atrium You may already know that your heart is a muscle that pumps blood throughout your body. In a person without a heart defect, blue blood that's low in oxygen flows first to the right atrium, then to the right ventricle, and is then pumped to the lungs to receive oxygen.


What is it?

Atrial septal defect (ASD) is a defect in the septum between the heart’s two upper chambers (atria). The septum is a wall that separates the heart’s left and right sides. Septal defects are sometimes called a “hole” in the heart.

Everyone is born with an opening between the upper heart chambers called the foramen ovale. It’s a normal opening that exists in the fetus (baby) before it is born that allows blood to detour away from the lungs before birth. After birth, the opening is no longer needed and usually closes or becomes very small within several weeks or months. Sometimes this opening is larger than normal and doesn’t close after birth. As many as one in five healthy adults still have a small leftover opening in the wall between the atria, sometimes called a Patent Foramen Ovale (PFO).

Defects that vary in size can occur in other parts of the septum. The defects are named according to their location. Small ASDs that are discovered in infants often close or narrow on their own. There isn’t any medicine that will make the ASD get smaller or close any faster than it might naturally. Some patients can have other heart defects along with ASD.


How long does the procedure take ?

The cardiac catheterization procedure for an ASD closure typically takes 1 to 2 hours to complete. A local anesthetic is used to numb the groin area where the catheter was inserted. Use of general anesthesia or sedation by IV is situation dependent -- depending on doctor preference and particular patient needs.


What types of ASD closure devices are there ?

Two main types of ASD closure devices are currently being used at the We Care India partner hospitals - the Amplatzer® Septal Occluder System and the HELEX® Septal Occluder.

What Causes an Atrial Septal Defect ?

Atrial septal defects develop when a baby is still growing inside its mother. Before birth, the heart begins as a large tube that folds and divides into sections that will eventually become the walls and chambers of the baby's heart. If a problem occurs during this process, a hole may develop in the wall between the left atrium and right atrium.


If U had surgery to close an ASD in childhood, what can U expect ?

A large ASD is usually closed in early childhood, even in patients with few symptoms, to prevent complications later. Some defects were closed with a patch of pericardium (the normal lining outside the heart) or synthetic material such as Dacron. However, many defects that required surgery may have been sewn closed without using a patch. The prognosis after ASD closure during childhood is excellent and late complications are uncommon.


What if the defect is still present? Should it be repaired in adulthood?

If the opening is small, surgery or other treatments may not be needed. Most large atrial septal defects now can be closed either with open-heart surgery or during a cardiac catheterization using a device inserted into the opening to plug it (referred to as interventional or therapeutic catheterization). However, if the ASD is in an unusual position within the heart, or if there are other heart defects such as abnormal connections of the veins bringing blood from the lungs back to the heart (pulmonary veins), the ASD cannot be closed with the catheter technique. Then surgery is needed. Even when the defect is discovered in adulthood, patients benefit from closure of large defects.


How does the body react to a Permanent Implant ?

The materials used in the occluders have a proven long-term safety history and have been widely used in heart surgery procedures. It’s not likely that the body will have a negative reaction to these devices. Within a few days, the body’s own tissue will begin to grow over the device. By 3 to 6 months, the device is completely covered by heart tissue and at that point becomes a part of the wall of the patient’s heart.

The patient will not be able to feel the device. The implant will not be affected by airport or other security sensors, or by any household appliances, or medical imaging methods. However, the clarity of MRI or CT images may be slightly reduced because of the wire frame on the occluder devices. For this reason, be sure to inform the imaging technician that you or your child has such a device in your heart. You will receive an identification card that should be carried with you/or by your child to show to medical personnel if necessary.


What follow-up tests and home care instructions are typically given following a catheter-based procedure for ASD closure ?

Within 24 hours after the procedure, a chest x-ray, electrocardiogram, and echocardiogram are conducted to make sure that the device is positioned correctly. Bed rest in the hospital for 6 hours after device placement is required. The patient may go home the evening of the procedure or possibly the following morning. The patient may experience minor pain at the catheter incision site and a slight sore throat for a few days if an ultrasound probe was used to check device placement. The patient will be instructed not to lift anything greater than 10 pounds for 1 week after the procedure. Your doctor will discuss when you or your child can return to regular activity (usually within a week).

Your doctor will prescribe medications that will need to be taken at home. Aspirin or other blood-thinning drug will need to be taken daily for 6 months or longer to prevent blood clots from forming. Antibiotics will also need to be taken 1 hour before certain medical procedures (for example, dental cleaning/dental surgical procedures as well as certain surgeries) for up to 1 year post device placement. Your doctor will provide information on which procedures will require antibiotic pre-treatment.

As with all medications, take them only as directed by your doctor, never stop taking the medication without talking with your doctor first, and call your doctor if you experience unpleasant reactions or have any concerns about the medication. Finally, a few follow-up return trips to the hospital will be necessary over the next year to monitor the patient’s heart and device placement. Each visi at 1 month, 6 months, and 1 year -- will include a chest x-ray, electrocardiogram, and echocardiogram.


Can a catheter-based ASD closure procedure be used in all cases ?


ASD Closure Devices cannot be used :

If the ASD is too large to be adequately closed by a catheter-based closure    device
If the particular patient’s heart structure will not allow an ASD closure device to    be used (for example, if there is not enough atrial septal tissue left to secure    the device)
If the particular patient’s blood vessels are too narrow to allow the    catheter- based delivery system to be used
If the patient has blood clots in his/her heart
If the patient needs surgery to fix other heart defects
If the patient has a bleeding disorder, untreated ulcer, or is unable to take    aspirin
If the patient has an active infection anywhere in the body (the device can be    implanted after the infection is completely gone)

If your ASD cannot be closed with a catheter-based procedure, your doctor will discuss other treatment options including open-heart surgery.

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