Atrial Septal Defect

Nonsurgical Closure of Atrial Septal Defects at Mayo Clinic

An "occluder" is inserted into the heart to close the atrial septal defect.

This relatively new procedure is done in the heart catheterization laboratory and avoids the need for surgery. A patch, usually resembling a small umbrella, is inserted into the damaged area through a small tube, called a catheter.

Presently, the only atrial septal defects that can be closed with this method are secundum atrial septal defects and patent foramen ovales. Both ASDs have an adequate rim around the hole on which the device is attached. Other limiting factors for the procedure may include multiple ASDs, short septal length, small left atrium, and unusual locations of the defects. So far, the results have been comparable to surgical results.

Mayo Clinic patients who are good candidates for a transcatheter procedure meet with members of the specialized team who will assist in their care and are encouraged to ask questions about the surgery and their experience at Mayo Clinic. They receive specific instructions to help prepare for the procedure.

Most patients are admitted to the hospital the morning of the procedure.

The need for more specialized tests is determined on an individual basis.

During the procedure

The patient is sedated and a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided into the heart. Once the catheter is in the heart, the surgeon will pass a special device, called a septal occluder, into the ASD.

The septal occluder, which resembles a closed umbrella, is delivered to the site of the defect inside a catheter. After the catheter tip is moved into place, the device is pushed out of the catheter, across the atrial septal defect. The umbrella patch is then opened to cover the hole and secured in place.

The procedure is performed under general anesthesia, and the implantation of the device is performed using transesophageal echocardiographic guidance — ultrasound pictures using a probe introduced into the esophagus (the tube that goes from the mouth to the stomach) for improved imaging of the heart structures.

Angiograms (pictures taken following dye injection) are performed to determine the size of the chambers and the size of the defect, and its location within the heart.

Following the procedure

Patients go to a recovery room for several hours and are monitored for vital signs (such as pulse and breathing) and heart sounds. Patients need to lay flat for about six hours after the catheter has been removed from the groin to prevent bleeding.

An electrocardiogram is done to record the electrical impulses in the heart. Intravenous fluids are given to help flush out the X-ray dye. An IV is used to administer blood thinners, and medications that dilate (relax and enlarge) the blood vessels may be given. Pain medication is available and patients are encouraged to take it as needed.

After leaving the hospital

Patients stay overnight in the hospital or go home the same day, depending on when the surgery takes place, the complexity of the procedure and the general health of the patient.

Determining when it is safe to drive, return to work or resume an exercise program varies with the individual, but is usually within a few days.

Within six to eight weeks, the implanted device acts as a framework which stimulates normal tissue to grow. The tissue growth is usually completed in two to six months.

Follow-up care

Following the procedure, patients will need to be on aspirin or a prescription anticoagulant for approximately six months to keep blood clots from forming on the device while the body heals over it.

Patients should take an antibiotic before any dental or surgical procedure, because bacteria can enter the bloodstream during these procedures and get into the heart. This could lead to a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis.

Most patients are evaluated at three to six months, and then, for one, two and three years following device implantation with possible echocardiograms, chest x-rays and electrocardiograms at specified intervals.

Complications

The risks are the same as any cardiac catheterization, which are rare. They include clot formation, bleeding, infection, and perforation of the heart, arrhythmias. There is also the rare risk of device embolization (moving out of the repair area), which may require surgical retrieval.