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.
Your child will not need an incision in the chest wall for this procedure.
At birth, every child 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 children, it stays open. In most cases, doctors do not know why this happens.
Many children 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 child.
If your child has a larger ASD, he or she may need some type of repair. Children 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 children 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.
Most children 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
- 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 child’s healthcare provider about the specific risk factors for your child.
Ask your child’s healthcare provider how to prepare your child for ASD transcatheter repair. Your child 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 child’s 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
- Your child will get anesthesia before the surgery starts. Your child 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 child’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.
Ask your child’s healthcare provider what will happen after the ASD transcatheter repair. You can generally expect the following:
- Your child will spend some hours in a recovery room.
- Your child's vital signs, such as heart rate and breathing, will be watched.
- Your child may need to lie flat for several hours after the procedure without bending his or her legs. This will help prevent bleeding.
- Your child’s healthcare provider might prescribe medicine that keeps your child’s blood from clotting (anticoagulants).
- Your child will get pain medicine if needed.
- Your child’s healthcare provider may order follow-up tests, like an electrocardiogram or an echocardiogram.
- Your child will likely need to stay in the hospital at least a day.
At home after the procedure:
- Ask what medicine your child needs to take. Your child may temporarily need to take antibiotics or medicine to prevent blood clots. Give pain medicines as needed.
- Have your child 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 your child has increased swelling, increased bleeding or drainage, a fever, or severe symptoms. A little drainage from the site is normal.
- Follow all the instructions your child's healthcare provider gives you about medicine, exercise, diet, and wound care.
For a short time after the procedure, your child will need regular monitoring by a cardiologist. After that, your child will need to see a cardiologist only occasionally. For a while after the procedure, your child might also need antibiotics before certain medical and dental procedures to help prevent an infection of the heart valves.
Before you agree to the test or the procedure for your child make sure you know:
- The name of the test or procedure
- The reason your child is having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- When and where your child is to have the test or procedure
- Who will do the procedure and what that person’s qualifications are
- What would happen if your child did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or your child has problems
- How much will you have to pay for the test or procedure
October 26, 2017
Vick GW, Bezold LI. Management and outcome of isolated atrial septal defects in children. UpToDate. http://www.uptodate.com/contents/management-and-outcome-of-isolated-atrial-septal-defects-in-children.
Ayden, Scott, MD,Bass, Pat F., III, MD, MPH