Atrial Septal Defect Transcatheter Repair for Children

What is an atrial septal defect transcatheter closure in children?

Atrial septal defect (ASD) transcatheter closure is a procedure to fix a hole in the atrial septum. The atrial septum is a wall that separates the right and left upper chambers in the heart (atria). This hole is called an atrial septal defect or ASD.

If this defect is present, blood can flow abnormally from the left atrium into the right atrium. This causes the heart to pump extra blood out to the lungs. This extra blood can damage the lung blood vessels if left untreated for a long time. Also, the right-side pumping chamber (right ventricle) can become enlarged. As a result, it has to pump harder than it should to get blood out to the lungs.

ASD transcatheter closure uses a long, flexible tube (catheter) and a small device to close this hole. An interventional cardiologist inserts the catheter through a blood vessel in the groin. Inside the catheter is a small device folded up like an umbrella. The cardiologist moves the catheter all the way to the heart’s septum. The small device comes out of the tube and plugs up the hole in the atrial septum. Then the cardiologist removes the catheter from the body. Over time, tissue grows over the device and holds it even more firmly in place. Your child will not need a cut (incision) in the chest wall for this procedure.

Why might your child need an ASD transcatheter closure?

At birth, every child has a normal small opening between the left and right atria. This hole often closes or becomes very small soon after birth. But in some children, it stays open. In most cases, healthcare providers don't know why this happens.

Many children with an ASD don’t need to have the hole closed. Very small holes may not let very much blood pass between the atria. In these cases, the heart and lungs don’t have to work much harder than normal. These smaller holes don’t cause any symptoms and don't need to be fixed. Sometimes these small holes will close up on their own. A healthcare provider might wait to see if that happens before planning to do a closure, especially in a very young child.

If your child has a larger ASD, they may need some type of procedure. Children with larger ASDs may have symptoms, such as shortness of breath. A large ASD can, over time, cause high pressure in the vessels in the lung. This then leads to low oxygen levels in the body. Healthcare providers often advise closure for children who have a large ASD, even if they don’t have symptoms yet. It can prevent long-term (permanent) damage to the lungs. Surgery is most common in children. But sometimes adults need this type of closure if their ASD wasn’t found during childhood.

Transcatheter closure of an ASD is less invasive than surgical closure. It also needs less recovery time. When it is a choice, healthcare providers often choose transcatheter closure instead of surgery. Transcatheter closure is only possible for certain kinds of ASDs. This includes those in the middle of the septum (called secundum). Atrial defects in other parts of the septum need surgical closure. Very large ASDs might need surgical closure as well. Transcatheter closure also may not be a choice if a child has other heart defects that need closure at the same time.

What are the risks of ASD transcatheter closure for a child?

All procedures have risks. Some possible risks of this procedure include:

• Abnormal heart rhythms

• Device becoming unattached and moving through the heart or vessels (embolization)

• Fluid buildup around the heart

• Infection

• Excessive bleeding

• Tear in the groin blood vessel where the catheter is inserted

• Temporarily reduced blood flow to the heart

• Collection of blood (hematoma) in the groin

• In rare cases, a hole (puncture) in the heart

It is also possible that the procedure will not successfully fix the ASD. Ask your child’s healthcare provider about the specific risk factors for your child.

How do I help my child get ready for an ASD transcatheter closure?

Ask your child’s healthcare provider how to get your child ready for an ASD transcatheter closure. Follow any directions your child is given for not eating or drinking before the procedure. They may also need to stop taking any medicine beforehand.

Your child may need some extra tests before the procedure. These might include:

• Chest X-ray. This shows the structures in and around the chest.

• Electrocardiogram. This checks the heart rhythm.

• Blood tests. These are done to check general health.

• Echocardiogram. This is done to see the heart and check blood flow through the heart.

What happens during an ASD transcatheter closure for a child?

Talk with your child’s healthcare provider about what to expect during the procedure. In general:

• Your child will get anesthesia before the surgery starts. Your child will sleep deeply and painlessly during the procedure. They won’t remember it later.

• The closure will take a few hours.

• The healthcare provider will put a small, flexible tube (catheter) into an artery in the groin. This tube will have a small device inside it.

• The provider will thread the tube through the blood vessel all the way to the atrial septum. Continuous X-ray images and echocardiogram may be used to see exactly where the tube is.

• In some cases, the provider may use a transesophageal echocardiogram. For this, the ultrasound probe is put into the child’s throat.

• The provider will push the small device out of the tube and place it across the hole in the atrial septum. Then the device will be secured in place.

• The tube will be removed through the blood vessel.

• The healthcare provider will close and bandage the site where the tube was put in.

What happens after an ASD transcatheter closure for a child?

Ask your child’s healthcare provider what will happen after the ASD transcatheter closure. You can generally expect the following:

• Your child will spend some hours in a recovery room.

• Your child's vital signs will be closely watched. These include heart rate, blood pressure, and breathing.

• Your child may need to lie flat for a few hours after the procedure without bending their legs. This will help prevent bleeding.

• Your child’s healthcare provider might prescribe medicine that keeps your child’s blood from clotting (anticoagulants).

• Your child will get pain medicine if needed.

• Your child may need follow-up tests, such as an electrocardiogram or an echocardiogram.

• Your child will likely need to stay in the hospital at least 1 day.

At home after the procedure:

• Ask what medicine your child needs to take. Your child may need to take antibiotics or medicine for a short time to prevent blood clots. Give pain medicines as needed.

• Don't let your child do any strenuous activities. Encourage them to rest.

• Any stitches will be removed in a later appointment. Keep all follow-up visits.

• Call the healthcare provider if your child has more swelling, more bleeding or drainage, a fever, or bad symptoms. A little drainage from the site is normal.

• Follow all the instructions your child's healthcare provider gives you about medicine, exercise, diet, and wound care.

For a short time after the procedure, your child will need regular watching by a cardiologist. After that, your child will need to see a cardiologist only now and then. For a while after the procedure, your child might also need antibiotics before certain medical and dental procedures. This is to help prevent an infection of the heart valves.

Next steps

Before you agree to the test or procedure for your child, make sure you know:

• The name of the test or procedure

• The reason your child is having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• When and where your child is to have the test or procedure

• Who will do the procedure and what that person’s qualifications are

• What would happen if your child did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or your child has problems

• How much you will have to pay for the test or procedure