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.

Getting Ready

The Week Before Your ASD closure:

• Talk to your caregiver about your medicines and allergies.
  
  
  • Tell your caregiver about all the medicines you take before your ASD closure. This includes prescriptions, over-the-counter medicines, herbs, and vitamins. Tell your caregiver if you are taking drugs used to treat erectile dysfunction, like Viagra® (sildenafil citrate).
    
    
  • Tell your caregiver if you have bleeding problems. Ask your caregiver for special instructions about your medicines. Be sure to ask about taking aspirin or other blood thinners before your ASD closure.
    
    
  • If you are a diabetic or have blood sugar problems, ask your caregiver for special instructions. Your caregiver may want to change your diet or medicine before and after the ASD closure.
    
    
  • A dye is a liquid that will be used during your right heart cath. It helps the parts of your heart to show up better. People who are allergic to shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• Go for tests. You may need to have blood tests, ECG or an chest x-ray. Ask your caregiver for information about these and other tests you may need. Write down the date, time, and location of each test.
  
  
• Arrange family support. Ask a family member or friend to plan to stay with you after the ASD closure. They can help you while you recover from the heart cath and ASD closure. You will need them to drive you home when you leave the hospital.

The Night Before Your ASD closure:

• You may be admitted to the hospital the night before your heart cath.
  
  
• Ask caregivers about directions for eating and drinking.

The Day Of Your ASD closure:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask caregivers before taking your medicines today. Ask your caregiver before taking any medicine on the day of the heart cath. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of your medicines or the pill bottles with you to the hospital.
  
  
• Wear your glasses. Do not wear contact lenses the day of surgery. You may wear your glasses.
  
  
• Bring personal belongings. If you are staying overnight in the hospital after the ASD closure, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers. Do not wear jewelry or bring money to the hospital.
  
  
• Take a full bath or shower before your ASD closure. Take a complete bath or shower and wash your hair before you come to the hospital. You may not be able to fully bathe until a few days after the procedure.
  
  
• Talk to the anesthesiologist (an-iss-thee-z-ALL-o-jist). An anesthesiologist may talk to you before your ASD closure. This is the caregiver who gives you medicine to keep you asleep and comfortable during the ASD closure.
  
  
• Make sure you have signed an informed consent. You or a close family member may be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do a heart cath. Be sure all your questions have been answered before you sign this form.

Treatment

What Will Happen:

• You will asked to change into a hospital gown. You may be given medicine to help you relax or make you drowsy. You will get an IV. You will be taken on a stretcher to the room where the ASD closure will be done. You will get medicine called local anesthesia (an-iss-THEE-zuh) that will numb the area where the catheter will go in. You may get general anesthesia to keep you asleep and comfortable during the ASD closure.
  
  
• 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.
  
  
• Next, 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, the pressure of blood between the right and left atria help hold it in place. 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 probe 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 to help them know the size of your ASD. They use it 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 the ASD closure:

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.

Waiting Room:

This is a room where your family can wait until you are ready for visitors after the right heart cath. Your doctor or nurse can then find them to let them know how the ASD closure went. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

Contact a caregiver if

• You cannot make it to your heart cath appointment on time.
  
  
• You have questions or concerns about your ASD or the heart cath.
  
  
• You have a fever.
  
  
• Your ASD problems get worse.