In the past, atrial septal defect (ASD) closure required open-heart surgery through an incision in the chest using a heart-lung bypass machine. This procedure would require three to five days in the hospital for recovery. It is now possible to close ASDs without surgery.
This is done during a heart procedure called a cardiac catheterization using a "patch" or special septal repair device that is placed permanently in the heart to cover the hole. The procedure takes about three hours to complete. You will be admitted to the hospital in the morning of the procedure and discharged later that day or the following morning.
The heart catheterization consists of placing a long, thin, hollow plastic tube, called a catheter, into the blood vessel in your groin and passing it through vessels into the heart's chambers. The catheter is used to gather blood samples and pressure measurements and to inject dye for X-ray movies. The size of the ASD will be measured and an appropriate size septal repair device will be selected for closure. If an ASD is unusually large, this procedure may not be possible. Surgical closure would then be necessary and would be scheduled for another time.
A septal repair device consists of two connected patches that are permanently placed in the hole to cover both the left and right atrial sides. After placement, within the first three months, the lining of the heart wall grows over the patch and seals the hole completely. There are several devices currently available for closure. The type and size of device is chosen after X-ray and echocardiogram movie pictures determine the size and location of the hole. Sometimes more than one device is needed to completely close the hole.
The procedure is safe with effective closure of the hole in 97 percent of more than 1,500 patients tested. The remaining 3 percent had surgical closure at a later date because the hole was too large or not centered in the atrial wall. Complications during the procedure are rare and almost all can be treated immediately. These include blood loss requiring a transfusion, allergic reaction to X-ray dye requiring medication, stroke and improper device position requiring retrieval by catheter technique or surgery. There is a small risk of blockage of the groin vessels used for catheterization and ordinarily it responds to medication.
Anticoagulation medication usually is prescribed after the operation for patients who also have arrhythmia. However, the risk for infection is low so antibiotics are recommended only for the first six months after surgery. Normal activities, including pregnancy, generally are safe.
Patients who have had repair of an atrial septal defect generally have a normal life. Most women can have normal uncomplicated pregnancies. A small percentage of patients may develop pulmonary hypertension — high pressures in the lung circulation — or abnormal heart rhythms. For this reason, it is recommended that a cardiologist with an interest in congenital heart disease evaluate all patients at least once during adulthood. A woman contemplating pregnancy also should be evaluated prior to conception. Thereafter, yearly follow-up is prudent.
Reviewed by health care specialists at UCSF Medical Center.
Cardiovascular Care and Prevention Center at Mission Bay
535 Mission Bay Blvd. South
San Francisco, CA 94158
Phone: (415) 353-2873
Fax: (415) 353-2528