An ASD is a congenital defect (present from birth) where a hole is present between two chambers of the heart: the left and right atria. This leads to an abnormal flow of blood from the left heart into the right heart, which leads to increasing strain on the right heart, which can damage the right side of the heart and lead to “cardiac failure” and palpitations..

What is a Patent Foramen Ovale (PFO)?

A PFO is “flap valve” communication between two chambers of the heart (the left and right atria) which usually closes after birth, but which can remain open into adulthood. This communication increases the likelihood of a person having a stroke, transient ischemic attack (TIA ) or systemic embolus, by allowing clots to pass from the venous circulation into the systemic arterial circulation and into the brain or elsewhere. Patients with PFO also have an increased prevalence of migraine.


How is Percutaneous Closure of an ASD or PFO Performed?

Under either local or general anaesthetic (depending on the defect), a puncture is made in the leg vein (femoral vein) and a wire is passed up to the heart and through the defect, under X ray and/or echo control. A trans-oesophageal echocardiogram is used for many defects to help guide placement. A sheath is then passed across the defect, and the closure device is then passed through the sheath and into the left atrium. The device is then pulled back, deploying the proximal part of the device on the left atrial side. Once the device is seen to be in a stable position, the device is released, and all sheaths and wires removed. A follow-up echocardiogram is often performed the next day to check the position is stable.

Herewith are links to videos describing ASD and PFO closure:

http://www.mercyangiography.co.nz/ProcedureVideos/ASDDevice.aspx

Amplatzer Septal Occluder

Benefits

For closure of atrial septal defect, the closure device usually leads to complete or near complete closure, and reduces the strain on the right heart. This will reduce the risk of the development of long term complications such as heart failure and arrhythmias.
For PFO closure, the closure device will prevent a clot from crossing from the venous circulation into the systemic circulation, and remove this as a cause of further strokes or TIAs.

Risks

Minor palpitations are not uncommon in the first month after implantation.
The risk of stroke, heart attack, severe bleeding or other complications is very rare.
If the anatomy of the atrial septum is unusual, and the defect is very abnormally situated near to atrial walls, there is a risk of the defect rubbing and eroding through the atrial walls, in the weeks or months after implantation. This would cause chest pain, and would require surgical removal of the device and surgical repair of the defect.

How do I Prepare?

You will be staying in hospital for one night following the procedure, so bring your toiletries and personal items for this period.
No food or drink 6 hours prior to the procedure.

Please notify the doctor if you have any allergies.

Please bring a list of all your current medications.
You will have been commenced on aspirin and clopidogrel before the procedure.

After the Procedure

You may have some bruising and soreness around the access site.

Do not lift objects over 5kg for 3-4 days after your procedure.

Notify your cardiologist or present at the emergency department if you have any significant chest pain, bleeding, pain, fevers, shortness of breath, blackouts or palpitations.

Do not perform hard physical activity for 30 days after discharge.

Follow-Up

Follow-up consultation, including further echocardiography will be made with your cardiologist.
Aspirin and clopidogrel are usually continued for 6 months after the procedure.

If you have any further questions, please contact us at:

Queensland Cardiology
Holy Spirit Northside Hospital
Suite 18, Level 3
Rode Road, CHERMSIDE
Ph (07) 38615522