What is ASD closure?
An atrial septal defect (ASD) is a hole in the wall (the septum) between the two upper chambers of the heart. It is present from birth, but some people may only find out about it as adults. Because of the hole, extra blood flows from the left to the right side of the heart, which over time can stretch the right side of the heart and raise the pressure in the lung arteries. ASD closure is a procedure in which a small, folded device made of fine metal mesh is passed through a vein in the groin up to the heart and opened across the hole, sealing it like an umbrella. Over the following months, the heart's own tissue grows over the device.
Why is it done?
Closure is recommended when the hole is large enough to cause the right side of the heart to enlarge, or when it causes symptoms such as shortness of breath, tiredness, palpitations or reduced exercise capacity. Closing it can prevent long-term problems such as heart failure, irregular heart rhythms and high pressure in the lungs. Most ASDs of the common type can be closed this way, avoiding open-heart surgery.
What happens on the day?
The procedure is done in the catheterisation laboratory, under general anaesthetic. An echocardiogram probe is placed in the gullet to give a clear picture of the hole and to guide the procedure. A thin tube is placed in a vein at the groin and guided to the heart. The size of the hole is measured, and a device of the correct size is placed across it and released once it is in a good position.
What to expect afterwards
You are monitored in the ward and the puncture site in the groin is checked regularly. Most patients stay one night and go home the next day after an echocardiogram confirms the device is in place. You will be given blood-thinning tablets for a few months while the device heals in, and may need antibiotics before dental work during this time. Follow-up echocardiograms are done to check the result.
Possible complications
Most patients do well and serious problems are uncommon. Possible complications include bruising or bleeding at the puncture site, temporary irregular heart rhythms, a blood clot forming on the device and rarely, the device moving out of position, wearing through the heart wall and causing a stroke or requiring open-heart surgery to remove it.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.