Atrial septal defect closure

Overview

ASD closure is a medical procedure aimed at closing an atrial septal defect (ASD), which is essentially a hole in the heart’s upper chambers. This defect, occurring in the atrial septum, is a condition present from birth and typically closes naturally in infancy. However, in cases where the hole remains open or is larger than usual, ASD closure becomes necessary. This procedure can be conducted through open-heart surgery or minimally invasive methods involving catheters and specialized devices like patches or sutures to seal the defect, thereby promoting proper heart function and circulation.

Reasons for undergoing the procedure

Small holes in the heart wall called atrial septal defects (ASD) usually don’t cause any issues and may not need treatment. However, when these holes are larger, they can lead to problems by allowing blood to flow where it shouldn’t in your heart. This can put extra strain on your heart and lungs, resulting in various symptoms and complications, such as:

• Abnormal heart rhythm, like atrial fibrillation or atrial flutter.
• Enlarged heart.
• Heart failure.
• Increased pressure in your lungs (pulmonary hypertension).
• Shortness of breath.
• Stroke.

If you’re at risk for these complications or already undergoing surgery for another heart condition, your healthcare provider may recommend closing the ASD. In some cases, especially with young children, surgeons perform ASD closure to prevent future heart damage and complications.

ASD closure is a procedure carried out by specialized heart surgeons or interventional cardiologists, experts in heart treatments.

Risk

Closing an atrial septal defect (ASD) is generally a safe and effective procedure; however, it does come with potential risks, such as:

• Irregular heart rhythm (arrhythmia).
• Kidney failure.
• Injury or puncture of heart tissue or veins, requiring surgical intervention.
• Allergic reactions to materials used in the procedure.
• Bleeding, which may necessitate a blood transfusion.
• Infection at the incision site or around the closure device.
• Stroke or a transient ischemic attack (mini-stroke).
• Some complications have the potential to be life-threatening.

Procedure

There are different ways to fix a hole in the heart known as an atrial septal defect (ASD). This can either involve open-heart surgery or a less invasive procedure called cardiac catheterization, where a thin tube is inserted through a vein in your groin and guided to your heart.

The hole can be repaired in a few ways:

• Patching it up: The hole can be covered using a special patch made from either artificial material or a piece of your own heart tissue, taken from elsewhere in your heart.
• Using a closure device: Another method is to plug the hole with a special device designed for this purpose.
• Stitches to the rescue: Alternatively, the hole can be sewn shut with stitches.

Your doctor will decide which method is best for you based on factors like:

• Any other heart problems you might have.
• The size and location of the hole.
• Your overall health.

In some advanced medical centers, they may even use robots to assist in this type of surgery.

During the procedure

Surgical ASD closure

During the surgical procedure to repair an Atrial Septal Defect (ASD), the patient is placed under general anesthesia to ensure they are completely unconscious and do not feel any pain during the operation.

Medical equipment is connected to the patient to continuously monitor essential vital signs like heart rate and breathing. Additionally, a heart-lung machine is employed to assist and maintain the heart’s function throughout the procedure.

The heart surgeon initiates the operation by making an incision in the patient’s chest. This incision can be performed in one of several possible locations:

• Down the center of the chest, directly over the breastbone.
• On the right side of the chest.
• In an alternative location as determined by the surgeon based on the patient’s unique medical condition.

Following the incision, the surgeon uses a specialized instrument to gently separate the ribs. Subsequently, an endoscope, a slender tube equipped with a light source and a camera at its tip, is inserted to locate the ASD within the heart. The surgeon then proceeds to close the ASD using various techniques, which may involve the use of a plug, patch, or sutures, depending on the specific requirements of the case.

Transcatheter ASD closure

Atrial septal defect (ASD) is a condition characterized by a small opening in the dividing wall of the heart’s upper chambers. For individuals without additional cardiac complications, a less invasive treatment option called transcatheter ASD closure is available. This method usually allows for a faster recovery than conventional surgery.

The transcatheter ASD closure process:

• Preparation: You may receive general anesthesia, which induces unconsciousness, or sedatives, which relax and make you drowsy without rendering you completely unconscious.
• Initiating the procedure: A minor incision is made near the groin to access a vein, usually the femoral vein, and occasionally an artery, the femoral artery.
• Device insertion: A thin, flexible tube called a catheter is threaded through this incision into the vessel, attached to a specialized device designed to mend the ASD.
• Navigating the device: Using advanced imaging tools such as X-rays and echocardiograms, the doctor visualizes your internal structures to guide the catheter and attached device to your heart.
• Sealing the defect: The device is precisely positioned and deployed to seal the ASD when the catheter reaches the appropriate location within the heart.
• Conclusion: The device remains in place to close the hole, and the catheter is removed.

This technique avoids a large chest incision and typically results in a much quicker recovery.

After the procedure

After undergoing ASD closure, your healthcare team will monitor your recovery from anesthesia and perform heart imaging to verify the procedure’s success. The duration of your hospital stay will vary, depending on the specific procedure you underwent.

Your healthcare provider will discuss your recovery expectations with you. Depending on whether you had surgical ASD closure or transcatheter closure, there are different recommendations for physical activity:

• Surgical ASD closure: May require limiting physical activity for a few weeks.
• Transcatheter closure Usually allows you to return to normal activity within a week.

After the procedure, you will likely need to take medications for about six months to prevent blood clots. Additionally, you should take antibiotics if you plan to undergo dental procedures within the first six months to prevent infections.

Outcome

Research indicates that individuals aged 25 or younger who undergo ASD closure have a life expectancy comparable to their peers who have never had an ASD. However, for older individuals receiving ASD closure, there is a slightly reduced lifespan compared to those who have not undergone the procedure. Crucially, individuals with ASD who undergo closure of the hole tend to have a longer life expectancy compared to those with ASD who do not undergo the procedure.

It’s crucial to attend all your follow-up appointments with your cardiologist or surgeon. During these visits, they will perform tests to check the effectiveness of the procedure, which may include:

• Wearing ambulatory monitors.
• Having echocardiograms.
• Participating in exercise stress tests.
• Undergoing electrocardiograms.

After ASD closure, watch for these serious complications and seek immediate medical attention if you experience:

•  Fever.
• Chest pain.
• Incision site discharge.
• Confusion or fainting.
• Unrelieved pain.
• Shortness of breath.
• Irregular heart rhythm.