Interventional Cardiology

Atrial septal defect closure (ASD)

How is an atrial septal defect treated?

Upon confirmation of an ASD, the treatment depends on the type and size of the defect, its effect on the heart, and whether any other related conditions such as pulmonary hypertension, valve disease or coronary artery disease are present. Your cardiologist is able to determine the best treatment for the ASD.

ASDs can be treated non-surgically (preferred method of treatment for most ASDs) however surgery might be needed to repair some types of ASDs particularly those that are very large. Surgical repair is usually performed using a tissue patch, preferably from the patient’s own pericardium (heart tissue). Some ASDs can be surgically closed with sutures alone. Prior to the introduction of a non-surgical approach, some 20 years ago, ASDs were only treated surgically, regardless of the type of defect.

How is the procedure performed?

At Intra we offer a non-surgical approach using an umbrella type septal occluder to treat the septal defect.

Septal occluders are made from an alloy of nickel and titanium. Each occluder has a nitinol wire mesh that is shaped into two flat discs and a middle, or "waist" to fit the defect size. The polyester fabric inserts are designed to help close the hole and provide a foundation for growth of tissue over the occluder after placement.

The procedure is conducted in an angiography suite (“cath lab”) at Intra, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your interventional cardiologist will be assisted by nurses and other highly trained staff. As the ASD closure is performed using general anaesthesia, you will not be aware of anything during the procedure.

At the start of the procedure, your interventional cardiologist inserts a catheter (soft plastic tube) from a small incision in the groin, into the heart using fluoroscopy (x-ray) guidance. This process, known as cardiac catheterisation, is used to determine the size and location of the septal defect as well as measure pressures inside the heart chambers. A very soft balloon is then inflated across the defect and the waist formed is able to be measured to confirm the size of the hole.

Following this, the closure device, attached to a catheter, is advanced to the heart and through the defect using x-ray guidance and echocardiography. The cardiologist then deploys the occluder to expand each disc on either side of the defect, closing off the hole. The procedure takes approximately one hour and you will remain in hospital overnight.

What will I experience during the procedure?

  • Fasting: You must not have anything to eat or drink six to eight hours before you procedure. You may continue to drink a small amount of clear fluids to take medications.
  • Medication: Please inform your cardiologist about all the medication you are taking. You cardiologist may advise you to stop taking some medication temporarily for a few days prior to your procedure e.g. blood thinners.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Intra staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic you should inform your cardiologist and Mercy Angiography staff at the time of booking your procedure. You may need to discuss your insulin dose with your cardiologist.

Please bring with you any medication and any recent blood test results, ultrasound results or x-rays.

On the day of your procedure, please firstly go to the Auckland Heart Group at 94 Mountain Road to meet with the cardiologist to have any final questions answered and to sign the consent form. Thereafter you will be directed to the Mercy Hospital Reception where they will be expecting you. You will be admitted to a hospital ward and transferred to Intra for your procedure.

What happens after my procedure?

  • After recovery from anesthesia and with adequate bed rest you should be able to sit up and move around.
  • You will stay in the hospital overnight and if there are no complications, you will be allowed to go home the next day following a transthoracic echocardiogram. 
  • Because the procedure is less invasive than open-heart surgery, your recovery should be easier and quicker.
  • You may have an adhesive bandage or band-aid where the catheter was inserted. You also may have a minor sore throat if an imaging probe (transoesophageal echo probe) was used.
  • Before you leave the hospital, your cardiologist will give you guidelines for activities and medications. They will also tell you when you can resume normal daily activities.
  • Medications will be an important part of your treatment and your doctor will prescribe drugs that you should take at home. The drugs should prevent blood clots from forming.
  • Notify your doctor if your medications cause unpleasant reactions, but do not stop taking them unless instructed to do so.