What is atrial septal defect transcatheter closure or repair?
Atrial septal defect (ASD) transcatheter repair is a procedure to fix a hole in the atrial septum. The atrial septum is a wall that separates the right and left upper chambers in the heart (atria). This hole is called an atrial septal defect or ASD.
If this defect is present, blood can flow abnormally from the left atrium into the right atrium. This causes the heart to pump extra blood out to the lungs. This extra blood can damage the lung blood vessels if left untreated for a long time. Also, the right-side pumping chamber (right ventricle) can become enlarged. As a result, it has to pump harder than it should to get blood out to the lungs.
ASD transcatheter repair uses a long, flexible tube (a catheter) and a small device to close this hole. An interventional cardiologist inserts the catheter through a blood vessel in the groin. Inside the catheter is a small device folded up like an umbrella. The cardiologist moves the catheter all the way to the heart’s septum. The small device comes out of the tube and plugs up the hole in the atrial septum. Then the cardiologist removes the catheter from the body. Over time, tissue grows over the device and holds it even more firmly in place.
The patient will not need an incision in the chest wall for this procedure.
Why might you need an atrial septal defect transcatheter closure or repair?
At birth, every patient has a normal small opening between the left and right atria. This hole often closes or becomes very small soon after birth. But in some patient, it stays open. In most cases, doctors do not know why this happens.
Many patients with an ASD don’t need to have the hole repaired. Very small holes may not let very much blood to pass between the atria. In these cases, the heart and lungs don’t have to work much harder than usual. These smaller holes don’t cause any symptoms and do not need to be fixed. Sometimes these small holes will close up on their own. A healthcare provider might wait to see if that happens before planning to do a repair, especially in a very young patient.
If you have a larger ASD, he or she may need some type of repair. patients with larger ASDs may have symptoms such as shortness of breath. A large, unrepaired ASD can eventually cause high pressure in the vessels in the lung. This, in turn, can lead to low levels of oxygen in the body. Healthcare providers often recommend a repair for patient who have a large ASD, even if they don’t have symptoms yet. It can prevent long-term, permanent damage to the lungs. The surgery is most common in children. But sometimes adults need this type of repair if their ASD wasn’t found during childhood.
Transcatheter repair of an ASD is less invasive than surgical repair. It also requires less recovery time. When it is an option, healthcare providers often choose transcatheter repair instead of surgery. Transcatheter repair is only possible for certain kinds of ASDs, such as those in the middle of the septum (called “secundum”). Atrial defects in other parts of the septum need surgical repair. Very large ASDs might require surgical repair as well. Transcatheter repair also may not be an option if a child has other heart defects that need repair at the same time.
What are the risks of atrial septal defect transcatheter closure or repair ?
Most patients do well with ASD transcatheter repair. But complications sometimes occur. Overall, the risk of complications is lower than in a surgical approach. Risk factors may vary based on age, the size of the defect, and other health problems. Possible risks include:
- Abnormal heart rhythms
- Device becoming unattached and moving through the heart or vessels (embolization)
- Buildup of fluid around the heart
- Infection
- Excess bleeding
- Puncturing the heart (rare)
- Tear in the groin blood vessel where the catheter is inserted
- Temporarily reduced blood flow to the heart
- Collection of blood (hematoma) in the groin
It is also possible that the procedure will not successfully fix the ASD. Ask your patient healthcare provider about the specific risk factors for patient.
How do I help my patient get ready for an atrial septal defect transcatheter closure or repair?
Ask your patient healthcare provider how to prepare your patient for ASD transcatheter repair. Your patient should not eat or drink anything after midnight before the day of the procedure. He or she may also need to stop taking any medicine beforehand.
Your healthcare provider may want to do some extra tests before the procedure. These might include:
- Chest X-ray
- Electrocardiogram, to check the heart rhythm
- Blood tests, to check general health
- Echocardiogram, to view heart anatomy and check blood flow through the heart
What happens during an atrial septal defect transcatheter closure or repair ?
Talk with your healthcare provider about what to expect during the procedure. In general:
- You will get anesthesia before the surgery starts. You will sleep deeply and painlessly during the procedure. He or she won’t remember it afterward.
- The repair will take about 2 hours.
- The healthcare provider will insert a small, flexible tube (catheter) into an artery in the groin. This tube will have a small device inside it.
- The healthcare provider will thread the tube through the blood vessel all the way to the atrial septum. X-ray images and echocardiogram may be used to see exactly where the tube is.
- In some cases, the healthcare provider may use a transesophageal echocardiogram, with the ultrasound probe inserted into the patient’s throat.
- The healthcare provider will push the small device out of the tube and place it across the hole in the atrial septum. Then the device will be secured in place.
- The tube will be removed through the blood vessel.
- The healthcare provider will close and bandage the site where the tube was inserted.
What happens after an atrial septal defect transcatheter closure or repair ?
Ask your patient’s healthcare provider what will happen after the ASD transcatheter repair. You can generally expect the following:
- You will spend some hours in a recovery room.
- You vital signs, such as heart rate and breathing, will be watched.
- You may need to lie flat for several hours after the procedure without bending his or her legs. This will help prevent bleeding.
- You healthcare provider might prescribe medicine that keeps you blood from clotting (anticoagulants).
- You will get pain medicine if needed.
- You healthcare provider may order follow-up tests, like an electrocardiogram or an echocardiogram.
- You will likely need to stay in the hospital at least a day.
At home after the procedure:
- Ask what medicine your patient needs to take. Patient may temporarily need to take antibiotics or medicine to prevent blood clots. Give pain medicines as needed.
- Have patient avoid strenuous activities. Encourage him or her to rest.
- Any stitches will be removed in a later appointment. Be sure to keep all follow-up visits.
- Call the healthcare provider if the patient has increased swelling, increased bleeding or drainage, a fever, or severe symptoms. A little drainage from the site is normal.
- Follow all the instructions patient's healthcare provider gives you about medicine, exercise, diet, and wound care.
For a short time after the procedure, the patient will need regular monitoring by a cardiologist. After that, the patient will need to see a cardiologist only occasionally. For a while after the procedure, the patient might also need antibiotics before certain medical and dental procedures to help prevent an infection of the heart valves.