|
Cardiac Implant Closure Device
Different types of
closure devices are used to close a hole or an opening between the right
and left sides of the heart. Some of these birth defects are located in
the wall (septum) between the upper chambers (atria) of the heart:
|
|
| |
| |
CardioSEAL®
Septal Occluder - used for PFO repair
Photo used with permission from NMT
Medical* |
Definition:
The percutaneous closure of
PFO and ASD is performed using a special closure device. The device is
folded or attached on to a special catheter, similar to the catheter used
during your catheterization. The special catheter is inserted into a vein
in the leg and advanced into the heart and through the hole. The device
is slowly pushed out of the special catheter allowing each side of the
device to open up and cover each side of the hole (like a sandwich), closing
the hole or defect. When the device is in proper position, it is released
from the special catheter. Over time, heart tissue grows over the implant,
becoming part of the heart. The PFO AND ASD closure procedure is monitored by X-ray and an
ultrasound camera inserted in the heart from a vein in the groin.
To prepare:
- You can wear whatever
you like to the hospital. You will wear a hospital gown during the procedure.
- Leave all valuables
at home. If you normally wear dentures, glasses or a hearing assist
device, plan to wear them during the procedure.
- Your doctor or
nurse will give you specific instructions about what you can and cannot
eat or drink before the procedure.
- Ask your doctor
what medications should be taken on the day of your test. You may be
told to stop certain medications, such as Coumadin (warfarin, a blood
thinner).
- If
you are diabetic, ask your physician how to adjust your medications
the day of your test.
- Tell your doctor
and/or nurses if you are allergic to anything, especially iodine, shellfish,
x-ray dye, latex or rubber products (such as rubber gloves or balloons).
- You may or may
not return home the day of your procedure. Bring items with you (such
as robe, slippers and toothbrush) that may make your stay more comfortable.
When you are able to return home, arrange for a companion to bring you
home.
What to expect:
- You will be given
a hospital gown to wear.
 A
nurse will start an intravenous (IV) line in your arm so that medications
and fluids can be administered during the procedure.- The cardiac catheterization
(cath) room is cool and dimly lit. You will lie on a special table. If you
look above, you will see a large camera and several TV monitors. You
can watch your cardiac cath on the monitors.
- The nurse will
clean your skin at the site where the catheter (narrow plastic tube)
will be inserted (arm or groin). Sterile drapes are used to cover the
site and help prevent infection. It is important that you keep your
arms and hands down at your sides and not disturb the drapes.
- Electrodes (small,
flat, sticky patches) will be placed on your chest. The electrodes are
attached to an electrocardiograph monitor (ECG), which charts your heart’s
electrical activity.
- You will be given
a sedative to relax you, but you will be awake and conscious during
the entire procedure.
- The doctor will
use a local anesthetic to numb the site. A plastic introducer sheath
(a short, hollow tube through which the catheter is placed) is inserted
a blood vessel in your arm or groin. A catheter will be inserted through
the sheath and threaded to the arteries of your heart.
First you will undergo a cardiac catheterization to determine the size and location of the hole in your heart. Measurements are taken of the pressure inside your heart chambers.
- When the catheter
is in place, the lights will be dimmed and a small amount of "contrast
material" may be injected through the catheters into your arteries
and heart chambers. The contrast material outlines the vessels, valves
and chambers.
- When the contrast
material is injected into your heart, you may feel hot or flushed for
several seconds. This is normal and will go away in a few seconds. Please
tell the doctor or nurses if you feel:
- an allergic reaction
(itching, tightness in the throat)
- nausea
- chest discomfort
- any other symptoms
- The x-ray camera
will be used to take photographs of the arteries and heart chambers. Measurements are taken of the pressures and oxygen content of the chambers in your heart and the size of your heart defect.
You will be asked to hold your breath while the x-rays are taken.
Sometimes an echocardiogram
or transesophageal
echocardiogram may also be used to better visualize the heart, chambers
and heart defect (ASD or PFO). A small catheter with an ultrasound transducer
is placed in your heart for continuous imaging during the procedure.
If the cardiac catheterization shows your heart defect is an appropriate size and in an appropriate location for closure with a device, the cardiologist uses a special catheter to advance the device to the heart defect.
The AMPLATZER® device consists of two wire mesh discs filled with polyester fabric (see photo above). When the device is in proper position, the device is slowly pushed out the catheter until the discs of the device sit on each side of the hole (like a sandwich).
The CardioSEAL® device consists of small double umbrella arms attached to Dacron fabric (see photo above), with special springs. When the device is in proper position, the device is slowly pushed out of the special catheter, the umbrella springs open, and covers each side of the hole (like a sandwich).
Once the physician is satisfied with placement of the device, it is released from the special catheter and is now implanted in your heart. Over time, heart tissue grows over the implant, becoming part of the heart.
The cardiac implant procedure
takes about 1 to 2 hours, but plan to spend about 5 to 9 hours from
the preparation through the recovery time.
After the procedure:
- The catheters and
sheath are removed from your groin. Pressure will be placed on the leg artery.
You will need to lie flat and keep the leg straight for three to six
hours to prevent bleeding. A pressure dressing will be applied tightly
on the groin. The nurse will check your bandage regularly, but call
your nurse if you think you are bleeding (have a wet, warm sensation)
or if your toes begin to tingle or feel numb. You will need to be
on bedrest for several hours.
- You may have some
tenderness in your groin at the site of insertion. Your throat may feel
slightly sore if an transesophageal echocardiogram was performed.
- You will need to
drink plenty of liquids to clear the contrast material from your body.
You may feel the need to urinate more frequently. This is normal.
- You will need to stay in the hospital overnight. The nurses will monitor your heart rate and rhythm. Before you leave the hospital, you will have an EKG, blood tests and a chest x-ray and/or echocardiogram to ensure the device is positioned properly.
- Before you leave the hospital, your doctor and nurse will discuss your medications and when you can return to normal activities. You will be prescribed a medication to prevent blood clots from forming, such as Aspirin for at least six months after the procedure. Your doctor will discuss follow-up and how long he would like you to continue your medications.
-
|
What is endocarditis?
Endocarditis
occurs when germs (especially bacteria) enter your blood stream
and attack the lining of your heart valves, causing growths on the
valve, holes in the valve or scarring of the valve tissue, most
often resulting in leaky heart valves.
|
Most children and adults with congenital
heart disease should be monitored by a heart specialist and take precautions
to prevent endocarditis throughout their life. Check with your doctor if you need to be protected from endocarditis life-long or may discontinue precautions 6 months after your procedure.
To protect yourself:
- Tell all doctors and dentists you have
congenital heart disease. You may want to carry a card with this information.
- Call your doctor if you have symptoms
of an infection (sore throat, general body aching, fever). Colds and
flues do not cause endocarditis. But infections, which may have the same
symptoms, do. So, to be safe, call your doctor.
- Take good care of your teeth and gums
to prevent infections. See your dentist for regular visits.
- Take antibiotics before you undergo any
procedure that may cause bleeding:
- any dental work (even a basic teeth
cleaning)
- invasive tests
- most major or minor surgery
- Check with your doctor about the type
and amount of antibiotics you should take.
Please ask your doctor
if you have any questions about cardiac implants.
Click
here to find a Cleveland Clinic Heart Center Cardiologist who performs the
cardiac implant procedure
*a
new browser window will open with this link. The inclusion of links to
other web sites does not imply any endorsement of the material on the
web sites or any association with their operators
© Copyright
2003-2006 The Cleveland Clinic Foundation. All rights reserved,11/06 |
