Until recently all patients with holes in the heart had open heart surgical closure.
The defect is closed by sewing a patch in place (if the defect is large) or by stitches (if the defect is small). Surgical patients usually stay overnight in the intensive care unit and then 3 to 5 days in the hospital and about 4 weeks recovery time at home. Percutaneous ASD closure involves closing the hole without needing to cut the chest. There is >95% chance of successful closure depending on the size of the hole.
This usually depends on the presence or absence of an ASD. The strategy used to close the ASD will depend on a number of parameters such as size position and presence of any other heart defects.
The strategy used to close the ASD will depend on a number of parameters such as size position and presence of any other heart defects.
What is involved and what are the risks?
You will be given general anaesthetic. The operation is guided by X-rays from the outside, and by ultrasound pictures from a probe in your throat. A pipe is passed from a needle puncture in the leg to the heart and a wire is passed across the hole in the heart. A stiff tube is passed over the wire and an umbrella device is placed across the hole. The pipes are taken out and the hole in the leg (where the pipes have been) is pressed on to stop the bleeding. You will stay overnight in hospital, and usually be back at week within 1 week.
The complication rate is low, about 1-2%. These are:
- Rhythm problems – these usually settle with medication; bleeding (see above);
- Device detachment- if the umbrella moves, then it has to be recaptured. If it cannot be recaptured, then surgery may be needed to remove it;
- Stroke- if a small clot forms on the device or any of the pipes and moves to the brain.
- Internal bleeding- there are wires and pipes in the heart and blood vessels to perform the procedure and the blood is thinned.
- In the long term, with big devices, some patients have developed internal bleeding due to erosion.
The pros and cons of treatment can be discussed with you in clinic.
Please see our live cases to see videos of Dr Malik performing ASD closure.