Non-Surgical Closure of Atrial Septal Defects (ASD)

Atrial septal defect (ASD) is a congenital heart defect, characterized by a hole in the muscular wall between the two upper chambers of the heart. During the development of the fetus, there is an opening between the upper chambers of the heart to allow blood to flow to the lungs. Normally the opening closes at the time of birth, but if it does not, the child is born with an atrial septal defect (ASD).

The causes for the development of atrial septal defects are not clear. However, genetic and environmental factors may contribute to the development of the birth defect. Your doctor may assess an atrial septal defect through echocardiography, chest X-rays and MRI scan.

Treatment of an ASD depends upon the type and size of the defect or presence of any other congenital heart defects. If an ASD is large, surgery to close the defect is recommended. ASD repair or closure may be performed through non-surgical methods or a surgical procedure. Depending upon your condition, your surgeon determines the appropriate type of repair procedure.

Procedure

The non-surgical closure of atrial septal defects (ASD) involves the following steps:

  • A tiny cut is made in the groin area.
  • A thin tube (catheter) is inserted into a blood vessel and guided to the heart.
  • An ASD closure device is attached to the catheter and advanced to the heart and through the defect, under the guidance of X-ray and intra-cardiac echocardiogram.
  • The closure device is then placed across the ASD opening and the defect is closed. Eventually, heart tissue grows around the implant and becomes part of the heart tissue.

There are different types of devices available such as Amplatzer Septal Occluder and GORE HELIX Septal Occluder. Patients may return to their regular activities without any restrictions. Patients are advised to take their prescribed medication for the specified time span to prevent clots from forming on the device.

Instructions for Patients with Atrial Septal Defect (ASD)

These general instructions may be altered by your doctor.

Atrial Septal Defect (ASD) is a malformation or an incomplete formation of the septum (wall) between the two upper chambers (atria) of the heart. The atria are divided by a thin wall, which forms early in life. In some patients, this wall does not form properly, which leads to the presence of a "hole" (an Atrial Septal Defect). In some people, an ASD can be asymptomatic and cause no problems. In others, the ASD can lead to enlargement of the right heart, heart failure, arrhythmias, and damage to the lungs. Your cardiologist may determine that your ASD requires closure with surgery or with a non-surgical technique utilizing the Amplatzer device.

Pre-Procedure Preparation

  • You are seen in the HeartPlace offices. Please arrange a consultation by calling the office of a Heartplace physician who performs this procedure.
  • You are treated with aspirin and Plavix (antiplatelets, blood thinner) for six months after the procedure. It is important to report all drug allergies and intolerances before the procedure.
  • You should familiarize yourself with the specific risks, benefits, and alternatives to the procedure during your visit.

Procedure

The procedure is performed in the cardiac cath lab at the Baylor Jack and Jane Hamilton Heart and Vascular Hospital. Intravenous sedation and antibiotics are administered before the procedure. An intracardiac echocardiogram (ICE) or transesophageal echocardiogram (TEE) is performed during the procedure. Through a catheter placed in the groin, the ASD size is measured with a special balloon. Thereafter, the appropriate device is used to close the ASD. After the procedure, the tube is removed from your groin area and manual pressure is used to stop the bleeding. After your sedation wears off, you are allowed to eat and ambulate in the hallways. A chest X-ray and an echocardiogram are performed. You will probably remain in the hospital overnight.

Risks

This procedure is effective, but it has associated risks that include death, stroke, TIA, infection of the device, the need for surgical removal of the device, bleeding requiring a transfusion, vascular damage, cardiac puncture requiring emergency surgery, severe cardiac rhythm problems, contrast allergy, kidney failure (temporary or permanent), esophageal damage caused by TEE, reaction to medication, bleeding, and intolerance to blood thinners. Other patient-specific risks may also apply. The long-term effects of this device (beyond ten years) are unknown. Adherence to follow-up and compliance with medications are critical.

Follow Up

  • Office visit and echocardiogram at one and six months.
  • Annual cardiology office visit.
  • Aspirin and Plavix daily for six months. (You should take Plavix with meals.) Report any evidence of bleeding complications to your physicians.
  • You will receive subacute bacterial endocarditis prophylaxis as determined by the American Heart Association guidelines. You should receive antibiotics for dental and certain other procedures for six months after the procedure. After six months, the device is covered by healthy tissue and no further endocarditis prophylaxis is necessary.
  • If you develop symptoms of shortness of breath, chest pain, irregular rhythm, passing out, stroke, or other cardiac symptoms, please contact us immediately.

These are general guidelines. Specific details will be given to you by our physicians and nurses during your visit.

Service Providers

Baylor All Saints

Baylor Heart Hospital

HeartPlace Plano