Atrial Septal Defect or ASD Closure
What is an ASD Closure?
This procedure treats a congenital (present at birth) heart defect known as atrial septal defect, or ASD. Children born with this condition have an opening in the dividing wall (or “atrial septum”) between the two upper chambers of the heart known as the right and left atria. ASD develops during the first eight weeks of pregnancy, when an event alters the heart’s normal development. The most common type of ASD is an ostium secundum atrial septal defect, which occurs when a part of the atrial septum fails to close completely while the heart is developing. As a result, an opening develops in the center of the wall separating the two atria. Depending on the size of the defect and the weight of the child, a physician may recommend an ASD closure for this condition.
What Happens During an ASD Closure?
During this procedure, the child is sedated before the cardiologist inserts a small, thin, flexible tube (catheter) into a blood vessel in the groin and guides it inside the heart. Next, the cardiologist passes a special device, called a septal occluder, into the open ASD, preventing blood from flowing through it. Once this procedure is complete, the cardiologist withdraws the catheter(s). Afterward, several gauze pads secured with a large piece of medical tape are placed over the insertion site to prevent bleeding. Sometimes a small, flat weight or sandbag is applied to help keep pressure on the catheterization site and decrease the chance of bleeding. If the cardiologist accessed the heart through blood vessels in the child’s leg, the child will be told to keep the leg straight for a few hours after the procedure to minimize the chance of bleeding.
Who is a Candidate?
Physicians determine the best way to treat a child’s ASD based on:
- A child's age, overall health and medical history
- Severity of the condition
- A child's tolerance for specific medications, procedures or therapies
- Expectations for the course of the disease
- Parental opinion or preference
Some ASDs close spontaneously as a child grows and do not require treatment. Once a cardiologist diagnoses an ASD, they will evaluate the child periodically to see if the ASD is closing on its own. Cardiologists typically recommend that an ASD be repaired if it has not closed on its own by the time a child starts school, to prevent lung problems that develop from long-term exposure to extra blood flow. The size of the defect also factors into the decision on whether to perform an ASD closure. The good news is children who have ASDs repaired in childhood can prevent problems later in life.
What Condition Does it Treat?
For a child with ASD, there’s a hole (or opening) in the dividing wall between the two upper chambers of the heart. As oxygen-rich (red) blood passes from the left atrium and through the opening in the septum, it mixes with oxygen-poor (blue) blood in the right atrium. Six to eight percent of all children born with congenital heart disease have an ASD. No one knows why, but girls have atrial septal defects at twice the rate of boys.
What Happens After the Procedure?
Following the procedure, a child is taken to a unit in the hospital where he or she will be monitored by nursing staff for several hours. How soon a child wakes up after the procedure depends on the type of sedation used as well as the child's individual reaction to the medication.
During the child’s recovery, a nurse monitors the pulses and skin temperature in the leg or arm used during the procedure.
Children may return home once they no longer need further treatment or monitoring. Parents receive written instructions regarding care of the catheterization site, bathing, activity restrictions, and any new medications their child may need to take at home.
Most children feel fairly comfortable once they’re home and can participate in mild activities. Children may get tired more easily at first, but typically fully recover and return to normal activities within a few weeks. A physician may recommend pain medications such as acetaminophen or ibuprofen for a child’s comfort. Physicians will discuss pain control with parents before children are discharged from the hospital. The cardiologist may recommend taking antibiotics for a limited time after discharge from the hospital to prevent bacterial endocarditis.