Atrial septal defect (ASD) closure

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.

Before the procedure

Fasting Please stop eating six hours before your

Allergies Please tell Intra staff at the time of booking if you have any food or medication allergies or previous reactions to X-ray contrast (dye).

Diabetes If you are a diabetic, please tell Intra staff at the time of booking. You may need to discuss your insulin/diabetes medication dose with your cardiologist.

Anticoagulation (blood thinner) If you are taking a blood thinner (e.g. warfarin, rivaroxaban, dabigatran, etc.), please advise Intra staff at the time of booking. You may be advised to stop taking these medication temporarily.

Other regular medications Continue these unless advised otherwise by your cardiologist. If you are taking a diuretic or water pills (e.g. frusemide, spironolactone) please advise Intra staff as you may need to withhold this on the morning of the procedure..

During the procedure

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.

After the procedure

You will be transferred to CIU where the nurses will monitor your recovery. It is important you remain lying flat on the bed for the next few hours. You will undergo an electrocardiogram (12-lead ECG) and echocardiogram before you go home to ensure the occluder device is in place and functioning well.

If appropriate you will be discharged the morning after an ASD closure.

What are the risks?

As with any procedure, there are potential risks involved. Your cardiologist will explain the procedure, discuss possible risks and answer any questions you may have. You will then be asked to sign the consent form. This will occur either at an earlier appointment, or on the day of your procedure