Atrial Septal Defect Transcatheter Closure In Children

WHAT YOU SHOULD KNOW:

• Atrial (A-tree-ull) septal (SEP-tull) defect transcatheter closure is also called "ASD closure". It is done to close a hole in the wall of your child's heart. ASD is a common heart defect that babies may be born with. The heart has 4 chambers or rooms called the atria (A-tree-uh) and the ventricles (VEN-trik-ulls). With an ASD, there is a hole in the septum (wall) between the 2 upper chambers, the right and left atria. An ASD causes some of the left atrium blood to flow into the right atrium. Your child's heart and lungs must work harder because of this.
  
  
• ASD closure is done during a heart catheterization (kath-uh-ter-ih-ZA-shun) or "heart cath". A heart cath is a procedure in which a catheter (long, thin, bendable tube) is gently threaded (pushed) into the heart. Your child's caregivers push a tiny device through the catheter and plug it into the ASD hole. The device may be shaped like a double-sided umbrella or clamshell. After the device is put in, heart tissue will grow over it in about 3 months. Your child may go home the same day or he may stay overnight in the hospital.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

• During an ASD closure, the catheter may make a hole in your child's blood vessel. This may cause bleeding, a bruise, and soreness around the place where the catheter went in. Your child could bleed and may need a blood transfusion (trans-FEW-shun) or surgery to repair the hole. Your child could get air bubbles or a blood clot from the heart cath or device. Air bubbles could give your child a stroke. Blood clots may go to your child's lungs or brain and cause a stroke. The clots may go to your child's arm or leg and stop the blood flow. Fluid could build up in your child's lungs and cause trouble breathing.
  
  
• Your child could get a collapsed lung or an infection. Your child could have an allergic (uh-LER-jik) reaction or kidney problems from the dye used during the procedure. A blood clot may form on the ASD closure device. The ASD closure device could move out of place. Then your child may need surgery to remove the device and repair the ASD hole with a patch or stitches. Caregivers will watch your child closely for these problems.
  
  
• If your child does not have an ASD closure, your child's health condition could get worse. Your child's heart could fail (wear out) and your child could die. Call your child's caregiver if you are worried or have questions about your child's medicine or care.

WHILE YOU ARE HERE:

Before Your Child's ASD Closure:

• Informed Consent:
  
  
  • You have the right to understand your child's health problem. You should understand what tests, treatments, or procedures may be done to treat your child's problem. Your child's caregiver should also tell you about the risks and benefits of each treatment.
    
    
  • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your child. A consent form is a legal paper that gives a caregiver permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Your child's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered. This way you will understand what may happen to your child.
  
  
• Blood Tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. It is tested to see how your child's body is doing before the ASD closure. Your child may need to have blood drawn more than once.
  
  
• Call Button: A call button may be in your child's hospital room. You or your child should use the call button if your child is having problems and a caregiver is needed. You can also use the call button if you or your child have questions for a caregiver. Be sure to keep the call button near you or your child at all times.
  
  
• Chest X-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are handling his heart problem.
  
  
• Gown: A hospital gown is needed so caregivers can easily check and treat your child. Your child's gown should be put on so it opens in the back. Your child may be able to wear regular pajamas or clothes after the ASD closure.
  
  
• Heart Monitor: This is a machine used to see how your child's heart is doing before, during, and after the ASD closure. 3 or 5 sticky pads are placed on your child's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing well.
  
  
• IV: An IV is a tiny tube placed in your child's vein (blood vessel). Your child's IV may be hooked to a machine that will give your child liquids and medicine. The IV may be put in your child's hand, arm, ankle, or foot. Before putting in the IV, caregivers may put a special numbing cream on your child's skin. This is so your child will feel little or no pain when the IV is put in.
  
  
• Pulse Check: Caregivers will check your child's pulses (heartbeat) in his feet and ankles. The pulse is the feeling under the skin when the heart pushes blood through the arteries (blood vessels). Your child's caregiver may put an "X" over the spots on your child's feet where the pulse is strongest.
  
  
• Pulse Oximeter (oks-IH-mih-ter): This is a machine that tells caregivers how much oxygen is in your child's blood. It will tell caregivers how well your child is doing before, during, and after the ASD closure. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe.
  
  
• Vital Signs: This may include taking your child's temperature, pulse (heartbeats), respirations (breaths), and blood pressure. Your child's temperature may be taken in the mouth, ear, armpit, or rectum (rear-end). Caregivers may also listen to your child's heart and lungs by using a stethoscope (STETH-o-skop).
  
  
• Transport to the Heart Cath Lab: Your child will be taken on a stretcher or crib to the room where the ASD closure will be done. Your child's caregivers will help your child get comfortable on the bed. A belt may be put over your child's legs for safety. Your child's arms may be tucked at his sides to give caregivers more room to work during the ASD closure.
  
  
• PreOp Care: This is care your child gets right before surgery. Your child will lie on a hard, movable x-ray bed. There will be large x-ray machines and other equipment in the room. Caregivers will clean the groin or other skin areas with soap. This soap may make your child's skin yellow, but it will be cleaned off later. Sterile (no germs) sheets will be put over your child to keep the area clean. Your child will have tubes put in him and equipment attached to him.
  
  
• Medicines: Your child may get one or more of these medicines before, during, or after the ASD closure.
  
  
  • Antihistamines (anti-HISS-ti-means): This medicine may be given to help decrease itching. This medicine may protect your child from a reaction to the dye.
    
    
  • Anti-Nausea Medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after the ASD closure.
    
    
  • Blood Thinner Medicine: This medicine may be given to prevent blood clots from forming during the heart cath and ASD closure.
  
  
• Anesthesia (an-iss-THEE-zuh): This is medicine that makes your child comfortable during surgery. Caregivers may work with you to decide which anesthesia is best for your child. After taking this medicine, your child may feel drowsy, dizzy, or have unclear thinking. Your child may sleep for a few hours after the ASD closure because of the anesthesia. Your child may get one or more types of anesthesia:
  
  
  • General Anesthesia: This is medicine that puts your child to sleep and makes him comfortable during surgery. It may be given as a liquid or in an IV. It may be given as a gas through a face mask. This medicine may also go through a tube placed in your child's mouth and throat. This tube is called an endotracheal (end-o-TRA-kee-ull) tube or "ET tube".
    
    
  • Local Anesthesia: Caregivers may put a special numbing cream on the places where the catheters may go in. Your child may get a shot of numbing medicine right before the catheter goes in.

During Your Child's ASD Closure:

• Your child will lie on a hard, movable x-ray bed. There will be large x-ray machines and other equipment in the room. Caregivers will clean the groin or other skin areas with soap. This soap may make your child's skin yellow, but it will be cleaned off later. Sterile (no germs) sheets will be put over your child to keep the area clean. Your child may have special tubes put in him and equipment attached to him during this time.
  
  
• Once your child is asleep, catheters will be put into the blood vessels in your child's groin, neck, or arm. The catheters are gently threaded (pushed) into the blood vessels and heart. Caregivers will close your child's ASD with a special device. Once the device is put over the ASD, pressure between the right and left atria help hold it in place. Heart tissue should grow over the device in about 3 months.
  
  
• When the ASD closure is finished, the catheters will be removed. Caregivers will put pressure on the area where the catheters came out. A pressure bag may be put in place for 2 or more hours. This is to stop the bleeding. Your child may also have stitches. It is very important for your child to lie flat. The leg or area that had a catheter in must be kept very flat and still to prevent bleeding.

After Your Child's ASD Closure:

• Aftercare: Your child will be taken to a recovery area. Later, your child's caregivers may take him to a hospital unit or room. Caregivers will watch your child closely for problems that can happen after a heart cath and ASD closure. Caregivers will take your child's vital signs every 15 minutes for 1 to 2 hours. The pulses in your child's feet or wrists will also be checked often. Your child's toes or fingers will be checked to see if they are warm. Tell your child's caregiver if your child has any of the following:
  
  
  • Chest pain or discomfort.
    
    
  • Change in color or temperature of your child's arm or leg.
    
    
  • Swelling or bleeding from the area where the catheter was.
    
    
  • Pain, numbness, or tingling in your child's arm or leg.
    
    
  • Swelling or bleeding from the area where the catheter was.
    
    
  • Pain in your child's back, thigh, or groin.
    
    
  • Nausea. Your child feels sick to his stomach.
    
    
  • Sweating a lot.
  
  
• Activity:
  
  
  • Your child will need to lie flat and still in bed for about 4 hours. Lying flat and still is very important. This helps to prevent bleeding. Your child's caregiver will tell you when it is OK for your child to get out of bed. Help your child to rest or play quietly in bed until the morning after the ASD closure.
    
    
  • Bring favorite books, electronic games, or videotapes that your child enjoys. These may help him to lie still when he is fully awake after the ASD closure.
    
    
  • Do not raise the head or foot of your child's bed without asking a caregiver. Do not remove your child's pressure bag or bandage. Tell your child's caregiver if your child is uncomfortable or tired of lying on his back. Caregivers may have ways to make your child more comfortable.
    
    
  • Ask a caregiver to help the first time your child gets out of bed. Your child may feel weak, dizzy, or sleepy because of the medicine during the ASD closure. Continue to help your child when he gets out of bed to prevent him from falling or hurting himself.
  
  
• Bathroom: Your child may use a bedpan or urinal during the time that he must lie flat. After your child's caregiver says it is OK to get out of bed, you may help your child walk to the bathroom.
  
  
• Eating and drinking: Ask a caregiver before giving your child anything to eat or drink after the ASD closure. Your child may be on a clear liquid diet. Your child may have things like water, apple juice, soup broth, or clear soda pop. If he does not feel sick to his stomach, your child may be able to eat "finger foods". These are foods that can be eaten while your child is lying flat in bed. Help your child to drink as much water as he can. This will help to flush out the dye from your child's body. It will also help keep your child hydrated (keep good body fluid levels).
  
  
• Tests: Your child's caregivers may order tests to see how your child is doing after the ASD closure. They may order blood tests. They may order a chest x-ray and echocardiogram (eh-ko-KAR-d-o-gram) before your child goes home. This is to make sure the ASD device is still in the right place after the ASD closure.