How is an Atrial Septal Defect (ASD) Closed Using a Catheter-based Procedure

A catheter is a long, thin, flexible, hollow tube that has many uses in health care. One use of a catheter in heart-related problems is to guide the placement of a device inside the heart. The device is used to fix a problem called an atrial septal defect (ASD).

What is an atrial septal defect?

An ASD is a hole in the wall (the septum) between the heart’s two uppermost chambers, the right and left atrium. This hole allows blood to flow in either direction between the left and right atrium.

ASDs may cause several problems. First, the right side of the heart now contains extra blood, and this extra blood flows to the lungs. Problems with blood flow puts strain on the heart because it has to pump this extra blood to the lungs. In addition, the strain put on this right side of the heart causes it to become weak or enlarged. This can lead to heart failure if left untreated.

An enlarged heart may also cause arrhythmias (irregular heart rhythms) to develop. This extra blood flow to the lungs may damage the arteries to the lungs over time, leading to high blood pressure in these vessels. Also, ASDs can sometimes allow blood clots from the body to enter the brain and cause a stroke.

How is a catheter used to close an atrial septal defect?

First, a catheter is inserted into a large vein through a small incision usually made in the inner thigh (groin area). Then it is slowly moved through the vein and into the heart. One or more tests will be done to measure the size of the ASD and to make sure there are no other defects.

Next, a device used to close the hole in the heart wall is moved through the catheter to the location of the hole. Once in the correct location, the ASD closure device is pushed out of the catheter. The device opens and expands it shape to straddle each side of the hole. This stops the abnormal flow of blood between the two atria chambers of the heart. The catheter is then removed and the procedure is complete. The device will remain in the heart permanently closing the hole in the heart wall.

Are there different types of closure devices?

Two types of ASD closure devices are approved for use in the United States. These are the Amplatzer® Septal Occluder System and the GORE HELEX® Septal Occluder. The two devices have different designs; however, how they are positioned and how they work is similar.

The Amplatzer® Septal Occluder consists of two attached circular discs. These discs are made of polyester fabric encased by a wire mesh made of a nickel-titanium metal alloy. Once the device is pushed out of the catheter, it opens up. The discs straddle the opening in the wall of the heart. The larger disc faces the left atrium and is sandwiched on top of a smaller disc. The smaller disc faces the right atrium. Once in the proper position, the hole is sealed.

The GORE HELEX® Septal Occluder consists of a circular wire frame made of a nickel-titanium metal alloy covered with a thin membrane made of Gore-Tex. Gore-Tex is a material that has been used in open-heart surgery for more than 20 years. Once the device is passed through the catheter, it opens up. Like the Amplatzer Septal Occluder, the device straddles the septal defect and the hole is closed.

How does the body react to a permanent implant?

The wire framework and other materials used to make closure devices have a proven long-term safety history and have been widely used in heart surgery procedures. Because of this, a reaction between these devices and the body is not likely. Within a few days after the procedure, 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. At that point, it becomes part of the wall of the patient’s heart.

The devices cannot be felt. Airport or other security sensors, household appliances, or medical imaging tests do not affect the devices. However, the clarity of MRI or CT images may be slightly reduced because of the wire frame on the devices. For this reason, imaging technicians need to be told if such a device has been implanted in the heart. An identification card is given to patients with implants. It should be carried at all times to show to medical personnel if necessary.

How long does the atrial septal defect closure procedure take?

An ASD closure procedure typically takes 1 to 2 hours to complete.

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

No. ASD closure devices cannot be used:

If an ASD cannot be closed with a catheter-based procedure, other treatment options -- including open-heart surgery -- are considered.

How does an open-heart surgical procedure compare with a catheter-based procedure?

The catheter-based procedure to close an ASD usually results in a much shorter hospital stay (typically 6 to 24 hours), and an easier and more rapid recovery. There is also less scarring (limited to the leg area where the catheter is inserted).

With open-heart surgery, an incision is made in the chest to expose the heart. A heart-lung bypass machine is used to pump blood for the heart while the heart is stopped and the wall defect is being repaired. The defect is closed by sewing a patch in place (if the defect is large) or by stitches (if the defect is small). Patients usually stay overnight in the intensive care unit, then spend 3 to 5 days in the hospital. Patients usually need about 4 weeks of recovery time at home. A scar on the chest results from open heart surgery. However, it may be the best or only option in some cases.

What follow-up tests and care are needed after repairing an atrial septal defect?

A chest x-ray, electrocardiogram, and echocardiogram are done within 24 hours of the surgery. These tests help detect any problems with the heart and check the position of the device. Bed rest in the hospital for 6 hours after device placement is required. Patients may go home the evening of the procedure or possibly the following morning. Patients may experience minor pain at the catheter incision site. Also, they may have a slight sore throat for a few days if an ultrasound probe was used to check device placement.

Patients should not lift anything heavier than 10 pounds for 1 week after the procedure. When patients can return to regular activity is determined by the doctor. Usually it is within a week.

Medications are prescribed to take 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 after the device has been placed.

All medications need to be taken only as instructed by your doctor. Patients should never stop taking any medication without talking with their doctor first. Patients need to call their doctor if they have unpleasant reactions or have any concerns about the medication.

Follow-up visits at the hospital are needed 1 month, 6 months, and 1 year after device placement. During these visits, a chest x-ray, electrocardiogram, and echocardiogram are taken to help detect any heart problems and check the position of the device.



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