Percutaneous Closure of Atrial Septal Defect and Patent Foremen Ovale

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

http://www.mercyangiography.co.nz/ProcedureVideos/PFODevice.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.