Atrial Septal Defect Transcatheter Closure

WHAT YOU SHOULD KNOW:

• Atrial (A-tree-ull) septal (SEP-tull) defect transcatheter (trans-KATH-uh-ter) closure (KLO-shur) is also called "ASD closure". ASD closure is done to close a hole inside your heart. ASD is a common heart defect that babies are born with. The heart has 4 chambers of 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 blood from the left atrium to flow back into the right atrium. Your 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 caregivers push a tiny device through the catheter and plug it over the ASD hole. The device may be shaped like a double-sided umbrella or coil. It is made of wire and mesh or cloth. After the device is put in, heart tissue will grow over it in about 3 months time. You may go home the same day or you may stay overnight in the hospital.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• There are risks in making a hole in a blood vessel with the catheter. This could cause bleeding, a bruise, and soreness around the place where the catheter went in. You could bleed so much that you may need a blood transfusion or surgery to repair the hole. You could get air bubbles or a blood clot from the heart cath or device. Air bubbles could give you a stroke. Blood clots may go to your lungs or brain and cause a stroke. The clots may go to your arm or leg and stop the blood flow. Fluid could build up in your lungs and cause trouble breathing.
  
  
• You could get a collapsed lung or an infection. You 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 you may need surgery to remove the device and repair the ASD hole with a patch or stitches. Caregivers will watch you closely for these problems.
  
  
• If you do not have an ASD closure, your health condition could get worse. Your heart could fail (wear out) and you could die. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Before Your ASD closure:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Gown: A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Foley Catheter (KATH-uh-ter): This is a tube put into your bladder to drain your urine. The bladder is an organ where urine is kept. The catheter may make you feel like you have to urinate. Relax and the catheter will drain the urine for you. When the catheter is taken out, you should be able to urinate on your own. The foley catheter is usually pulled out shortly after your ASD closure.
  
  
• Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pulse Check: Caregivers will check the pulses (heartbeat) in your feet and ankles. The pulse is the feeling under the skin when the heart pushes blood through your arteries. Your caregiver may put an "X" over the spots on your feet where the pulse is strongest.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Transport to the Heart Cath Lab: You will be taken on a stretcher to the room where your procedure will be done. Your caregiver will help you get comfortable on the bed. A belt may be put over your legs for safety. Your arms may be tucked at your sides to give your caregivers more room to stand beside you.
  
  
• Medicines: You may be given medicine before, during, or after the ASD closure. This medicine may make you feel sleepy and more relaxed. You may also receive the following types of medicines:
  
  
  • Anti-anxiety medicine: This medicine may be given to help you feel less nervous and more relaxed.
    
    
  • Antibiotics (an-ti-bi-AH-tiks): This medicine may be given to help you fight infection caused by a germ called bacteria (bak-TEER-e-uh).
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Blood thinners: This medicine helps stop clots from forming in your blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it easier for you to bleed or bruise. If you shave, use an electric shaver. Use a soft toothbrush to help keep your gums from bleeding.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
    
    
  • Antihistamines (anti-HISS-ti-means): This medicine may be given to help decrease itching. This medicine may protect you from a reaction to the dye used during the ASD closure.
    
    
  • Steroids (STAIR-oyds): This medicine may be given to decrease inflammation (in-fluh-MA-shun) which is redness, pain, and swelling. This medicine may protect you from a reaction to the dye.
  
  
• Anesthesia (an-iss-THEE-zuh): This is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best for you. Do not make important decisions for 24 hours after having anesthesia. Also, do not drive or use heavy equipment. The medicine may make you drowsy and your thinking unclear. An adult may need to drive you home and stay with you after you have had anesthesia.
  
  
  • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
    
    
  • Local anesthesia: This is medicine to make you more comfortable during your procedure or surgery. It is a shot of medicine put into the skin. It is used to numb the area and dull your pain. You may still feel pressure or pushing during the procedure or surgery after you get this medicine.

During Your ASD closure:

• You will lie on a hard movable x-ray bed. There will be large x-ray machines and other equipment in the room. Your skin may be shaved over the area where the catheter will go in. Your caregiver will clean this skin area with soap. This soap may make your skin yellow, but it will be cleaned off later. Sterile (no germs) sheets will be put over you to keep the area clean.
  
  
• Two catheters may be put in. One may go into your vein and one into your artery. These catheters are usually put into your groin area. The catheters are gently threaded (pushed) to the heart chambers (rooms) and blood vessels. Your caregivers may do regular heart caths first. They may check the pressure and oxygen levels in your heart and blood vessels.
  
  
• Your caregivers may use dye and x-rays to look at your ASD. They will look at the size of the ASD hole and where it is on your heart wall. Your caregivers will close your ASD hole with a special device. Once the device is put over the hole, pressure between the right and left atria help hold it in place. Caregivers may again use dye and x-rays to make sure the device is in the right place over the ASD. Heart tissue will grow over the device in about 3 months. Caregivers may use one or more of the following during the ASD closure:
  
  
  • Fluoroscopy (floor-OS-ko-pee): This machine sends a constant beam of x-rays toward your heart. It puts a picture of your heart on a TV screen. Caregivers use the TV pictures to help them push the catheter to the right places in the blood vessels and heart. They look at the size and place of the ASD and the size of your heart chambers (rooms). Caregivers may use fluoroscopy to make sure the device is placed over the ASD hole in the right way.
    
    
  • Balloon-tipped catheter: This catheter is put in the middle of your ASD hole. The tip is inflated (filled up with fluid) like a tiny balloon. This helps your caregivers to pick the right sized device for closing your ASD.
    
    
  • Transesophageal (trans-e-SOF-uh-g-ull) echocardiogram (eh-ko-KAR-d-o-gram): This is also called a "TEE". Caregivers gently put a tiny camera down your throat. A constant beam of ultrasound (sound) waves are put over your heart. Your heart will show up on another TV screen. Caregivers use a TEE and color Doppler pictures to help them know the size of your ASD. Color Doppler pictures make your heart and blood flow show up on the TV screen in different colors. Caregivers may use a TEE to make sure the device is placed over the ASD hole in the right way.
  
  
• The catheter will be removed and a tight pressure bandage will be put on your wound. Caregivers will put pressure on the area where the catheter came out to stop bleeding. A pressure bag may be put on the places where your catheters came out for 2 or more hours. You may have a collagen plug or stitches to stop the bleeding. It is very important to lie still and flat after the heart cath is over. This is to prevent bleeding.

After Your ASD closure:

• Aftercare: You will be taken back to your room or to a recovery area. If you had an ET tube put in your throat, it may be taken out in the heart cath lab. Or, it may be taken out in the recovery area. Caregivers will take your vital signs every 15 minutes for 1 to 2 hours. The pulses in your feet or wrist will also be checked often. Your toes or fingers will be checked to see if they are warm. You may feel sleepy for a few hours after the ASD closure because of the anesthesia. Tell your caregiver if you have any of the following:
  
  
  • Chest pain or discomfort.
    
    
  • A change in color or temperature of your arm or leg.
    
    
  • Pain, numbness, or tingling in your arm or leg.
    
    
  • Swelling or bleeding from the area where the catheter was.
    
    
  • Pain in your back, thigh, or groin.
    
    
  • Nausea (sick to your stomach).
    
    
  • Sweating a lot.
  
  
• Activity:
  
  
  • You may be very sleepy after the ASD closure. This is because of the anesthesia medicine. You will need to lie flat and still in bed for at least 4 to 6 hours. Lying flat and still is very important. This helps to prevent bleeding. Your caregiver will tell you when it is OK to get out of bed.
    
    
  • Do not raise the head or foot of your bed without asking a caregiver first. Do not remove your pressure bag or bandage.
    
    
  • Tell your caregiver if you get tired of lying on your back. Caregivers may have ways to make you more comfortable.
    
    
  • Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.
  
  
• Bathroom: You must use a bedpan or urinal during the time that you must lie flat. Or, you may have a foley catheter in. If you do, relax and let the catheter drain your urine for you. Also do the following:
  
  
  • Do not pull on the catheter because this will make you hurt or bleed.
    
    
  • Do not kink or lie on the catheter tube because the urine will not be able to drain.
    
    
  • Do not lift the bag of urine above your waist. If you do this, the urine will flow back into your bladder. This can cause an infection.
  
  
• Eating and drinking:
  
  
  • You may be able to eat when bowel sounds (stomach growling) are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope (STETH-uh-skop). Ice chips are usually given first and then liquids (water, broth, apple juice, or clear soda). Caregivers may ask you to drink as much liquid as you can. This is to help your body get rid of the dye used during the ASD closure.
    
    
  • If you do not have problems after drinking liquids, caregivers may then let you eat soft foods. Some examples of soft foods are ice cream, applesauce, or custard. If you do OK with soft food, you may begin eating a regular diet.
  
  
• Tests: Your caregivers may order tests to see how you are doing after the ASD closure. They may order blood tests. They may order a chest x-ray and echocardiogram before you go home. This is to make sure the ASD device is still in the right place after the ASD closure.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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