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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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 from the heart cath or device. Air bubbles could give you a stroke. 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 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. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• 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: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• 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 to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• 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 or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• 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 device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• 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:
  
  
  • Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and 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 to help prevent vomiting.
    
    
  • Blood thinners: This medicine helps prevent clots from forming in the blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
    
    
  • 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: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
    
    
  • Local anesthesia: Medicine is used to numb the area of your body where the surgery or procedure will be done. It is usually injected into the skin. It also may be given as a gel or jelly applied to your gums for dental procedures or as a patch. For such areas as the genitals, medicine may be given as a cream on the skin or mucus membranes.

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.

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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.