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ASD Device Closure

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The image of the heart shows the Atrial septal defect.
Image Credit: mayoclinic.org
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Atrial Septal Defect 
Device Closure Explained

An ASD device closure is a therapeutic procedure designed to address an Atrial Septal Defect (ASD) - an unusually large hole present between the upper chambers of the heart that persists after birth. If left untreated, this condition can result in heart enlargement, abnormal heart rhythms, and potential damage to the lung's blood vessels.

The ASD (Atrial Septal Defect) device closure procedure utilizes a specialized device to effectively seal the hole. It employs a patch to cover it or utilizes sutures to close it. There are several techniques available for ASD closure. While some cases may necessitate open-heart surgery, others can be addressed through a minimally invasive method known as cardiac catheterisation. In this approach, a catheter is threaded from a vein in your groin up to your heart.

Turn to Dr Karthigesan, a highly experienced specialist in ASD device closure procedures. With his impressive track record and exceptional skill set, he can provide the expert care you need to navigate this health challenge. Entrust your heart to the best; choose Dr Karthigesan for your ASD device closure.

A close-up shot of Atrial Septal Defect (ASD) device.
Image Credit: dicardiology.com
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The image illustrates the Atrial Septal Defect (ASD) Device Closure procedure.
Image Credit: cardiovascular.abbott

Atrial Septal Defect (ASD) Device Closure: Understanding the Necessity

While all babies are born with a small hole that typically closes within a few weeks or months, some babies may have a larger opening that does not seal naturally.

If the hole is too small( called PFO), it may not cause any symptom during daily activity but occasional shunting of blood across the hole might cause brain stroke. Hence it is recommended to close the PFO with device in Cryptogenic stroke. The ASD can lead to blood leakage into inappropriate chambers of the heart. Over time, this condition forces the heart and lungs to work harder, potentially triggering a series of health complications and symptoms such as:

  • Abnormal heart rhythm (arrhythmia), including conditions like atrial fibrillation or atrial flutter.
  • An enlarged heart.
  • Risk of stroke.
  • Heart failure.
  • Shortness of breath.
  • Elevated pressure in the lungs, leading to pulmonary hypertension.

ASD closure devices are not only used to prevent the above complications but also to avert strokes in individuals with a small ASD or patent foramen ovale (PFO). Similar to an ASD, a PFO allows blood to move in the wrong direction within the heart which can lead to stroke.

Assessment for Atrial Septal Defect (ASD) Device Closure

To fully understand your heart's condition and provide a detailed view of the ASD for an effective closure procedure, Dr Karthigesan may suggest you to undergo a series of diagnostic tests, including:

  • A Chest X-ray, which provides insights into the structure of your heart.
  • A Doppler Ultrasound to evaluate the flow of blood through your heart.
  • An Echocardiogram, which presents a detailed picture of your heart's anatomy and blood circulation.
  • An Electrocardiogram (ECG) to assess your heart's rhythm.
  • Transesophageal and transthoracic echocardiograms to gauge the size and location of the ASD and to determine the suitability of the procedure.
An image illustrates Atrial Septal Defect (ASD).
Image Credit: media.springernature.com
Image showing the Atrial Septal Defect (ASD) Device Closure by device and patch.
Image Credit: heart.org

The Atrial Septal Defect (ASD) Device Closure Procedure

  • The ASD closure procedure can be performed either through open-heart surgery by surgeons or by cardiologists using a catheter.
  • During a transcatheter ASD device closure procedure, a slim, flexible tube (catheter) is inserted into a blood vessel, generally in the groin area.
  • Using advanced imaging techniques, the catheter is carefully guided to the heart.
  • A mesh patch or plug is then transported through the catheter to effectively seal the hole.
  • Initially, the natural pressure within the heart secures the device in place. Over time, the heart's normal tissue grows over the implant, leading to the permanent closure of the hole.
  • If the ASD is exceptionally large or situated too close to the heart's wall, device use may not be a safe option. In such cases, heart surgery becomes necessary.

Taking Care Before, During, & After the ASD Device Closure Procedure

  • Dr Karthigesan will suggest you to take appropriate blood thinners.
  • You will be getting admitted on the day of the procedure.
  • Doctors will instruct you to avoid taking food 4 to 5 hours before the procedure.
  • The procedure begins with a keyhole in your groin, through which a sheath, a hollow plastic tube, is inserted into a blood vessel.
  • A catheter equipped with a closure device is guided through this sheath.
  • Utilising X-ray and echocardiogram imaging, the catheter is precisely directed to your heart.
  • Multiple measurements are taken to assess your heart's blood pressure and oxygen levels.
  • The closure device is then strategically placed into the hole in your heart.
  • Upon completion of the procedure, both the catheter and the imaging probe are carefully removed.
  • Pressure is applied to the keyhole site, or occasionally a small suture is used to seal the vein.
  • You will be advised to take bed rest for several hours to prevent bleeding. Report any instances of bleeding to your doctor immediately.
  • Medications such as aspirin are prescribed to mitigate the risk of blood clots.
  • Ensure that you avoid strenuous activities and heavy lifting for at least six months post-procedure.

Advantages of ASD Device Closure Procedure

  • The procedure significantly enhances your heart's functioning and minimizes your risk of complications related to ASD, including heart failure and stroke.
  • Patients generally experience a quicker recovery than they would from open-heart surgery, spend less time in the hospital, and face fewer post-procedure complications.
  • Compared to more invasive procedures, patients report less pain following catheter-based techniques.
  • This non-surgical procedure is performed without making a large opening, resulting in a scarless chest.
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ASD Closure -  Answers to Your Queries

After undergoing a transcatheter ASD closure, patients typically find themselves capable of returning to their regular activities within a week's time. It is often necessary to take anti-coagulant medications for a period of around six months post-procedure to mitigate the risk of blood clot formation. It is also crucial to attend all scheduled follow-up appointments to ensure optimal recovery and monitor health progress.
Research suggests that younger individuals (those aged 25 or younger) who undergo an ASD closure procedure have a life expectancy comparable to their peers without a history of ASD. Importantly, those with an ASD who opt for closure generally exhibit a longer lifespan compared to individuals with an ASD who do not undergo the procedure.
In rare instances, some patients may require repeat surgery to close a residual opening post-ASD closure or to address a hole that has reopened. This additional procedure is necessary only if the hole is sufficiently large to cause medical complications.

Yes, though the risk of complications associated with a transcatheter ASD closure is comparatively lower than with surgical ASD closure procedures. Although rare, potential complications can include bleeding, arrhythmia, infection around the closure device or keyhole site, kidney failure, or stroke or transient ischemic attack (TIA).

The majority of individuals diagnosed with ASDs can be considered suitable candidates for a catheter-based closure procedure. However, for those with a particularly large hole or additional heart defects in conjunction with an ASD, Dr Karthigesan may advise a more invasive, open-chest ASD closure.
Yes. The hole may not cause any symptoms during daily activity if it is too small (called PFO), but occasional shunting of blood across the hole could lead to brain stroke. Therefore, it is recommended to close the PFO with a device when there is a Cryptogenic stroke.
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