Different types of closure devices are used to close a hole or an opening between the right and left sides of the heart. Some of these birth defects are located in the wall (septum) between the upper chambers (atria) of the heart:
CardioSEAL® Septal Occluder - used for PFO repair
Photo used with permission from NMT Medical
The percutaneous closure of PFO and ASD is performed using a special closure device. The device is folded or attached on to a special catheter, similar to the catheter used during your catheterization. The special catheter is inserted into a vein in the leg and advanced into the heart and through the hole. The device is slowly pushed out of the special catheter allowing each side of the device to open up and cover each side of the hole (like a sandwich), closing the hole or defect. When the device is in proper position, it is released from the special catheter. Over time, heart tissue grows over the implant, becoming part of the heart. The PFO AND ASD closure procedure is monitored by X-ray and an ultrasound camera inserted in the heart from a vein in the groin.
- You can wear whatever you like to the hospital. You will wear a hospital gown during the procedure.
- Leave all valuables at home. If you normally wear dentures, glasses or a hearing assist device, plan to wear them during the procedure.
- Your doctor or nurse will give you specific instructions about what you can and cannot eat or drink before the procedure.
- Ask your doctor what medications should be taken on the day of your test. You may be told to stop certain medications, such as Coumadin (warfarin, a blood thinner).
- If you are diabetic, ask your physician how to adjust your medications the day of your test.
- Tell your doctor and/or nurses if you are allergic to anything, especially iodine, shellfish, x-ray dye, latex or rubber products (such as rubber gloves or balloons).
- You may or may not return home the day of your procedure. Bring items with you (such as robe, slippers and toothbrush) that may make your stay more comfortable. When you are able to return home, arrange for a companion to bring you home.
What to expect:
- You will be given a hospital gown to wear.
- A nurse will start an intravenous (IV) line in your arm so that medications and fluids can be administered during the procedure.
- The cardiac catheterization (cath) room is cool and dimly lit. You will lie on a special table. If you look above, you will see a large camera and several TV monitors. You can watch your cardiac cath on the monitors.
- The nurse will clean your skin at the site where the catheter (narrow plastic tube) will be inserted (arm or groin). Sterile drapes are used to cover the site and help prevent infection. It is important that you keep your arms and hands down at your sides and not disturb the drapes.
- Electrodes (small, flat, sticky patches) will be placed on your chest. The electrodes are attached to an electrocardiograph monitor (ECG), which charts your heart’s electrical activity.
- You will be given a sedative to relax you, but you will be awake and conscious during the entire procedure.
- The doctor will use a local anesthetic to numb the site. A plastic introducer sheath (a short, hollow tube through which the catheter is placed) is inserted a blood vessel in your arm or groin. A catheter will be inserted through the sheath and threaded to the arteries of your heart.
First you will undergo a cardiac catheterization to determine the size and location of the hole in your heart. Measurements are taken of the pressure inside your heart chambers.
- When the catheter is in place, the lights will be dimmed and a small amount of "contrast material" may be injected through the catheters into your arteries and heart chambers. The contrast material outlines the vessels, valves and chambers.
- When the contrast material is injected into your heart, you may feel hot or flushed for several seconds. This is normal and will go away in a few seconds. Please tell the doctor or nurses if you feel:
- an allergic reaction (itching, tightness in the throat)
- chest discomfort
- any other symptoms
- The x-ray camera will be used to take photographs of the arteries and heart chambers. Measurements are taken of the pressures and oxygen content of the chambers in your heart and the size of your heart defect. You will be asked to hold your breath while the x-rays are taken.
- Sometimes an echocardiogram or transesophageal echocardiogram may also be used to better visualize the heart, chambers and heart defect (ASD or PFO). A small catheter with an ultrasound transducer is placed in your heart for continuous imaging during the procedure.
- If the cardiac catheterization shows your heart defect is an appropriate size and in an appropriate location for closure with a device, the cardiologist uses a special catheter to advance the device to the heart defect.
- The AMPLATZER ® device consists of two wire mesh discs filled with polyester fabric (see photo above). When the device is in proper position, the device is slowly pushed out the catheter until the discs of the device sit on each side of the hole (like a sandwich).
- The CardioSEAL® device consists of small double umbrella arms attached to Dacron fabric (see photo above), with special springs. When the device is in proper position, the device is slowly pushed out of the special catheter, the umbrella springs open, and covers each side of the hole (like a sandwich).
- Once the physician is satisfied with placement of the device, it is released from the special catheter and is now implanted in your heart. Over time, heart tissue grows over the implant, becoming part of the heart.
- The cardiac implant procedure takes about 1 to 2 hours, but plan to spend about 5 to 9 hours from the preparation through the recovery time.
After the procedure:
- The catheters and sheath are removed from your groin. Pressure will be placed on the leg artery. You will need to lie flat and keep the leg straight for three to six hours to prevent bleeding. A pressure dressing will be applied tightly on the groin. The nurse will check your bandage regularly, but call your nurse if you think you are bleeding (have a wet, warm sensation) or if your toes begin to tingle or feel numb. You will need to be on bedrest for several hours.
- You may have some tenderness in your groin at the site of insertion. Your throat may feel slightly sore if an transesophageal echocardiogram was performed.
- You will need to drink plenty of liquids to clear the contrast material from your body. You may feel the need to urinate more frequently. This is normal.
- You will need to stay in the hospital overnight. The nurses will monitor your heart rate and rhythm. Before you leave the hospital, you will have an EKG, blood tests and a chest x-ray and/or echocardiogram to ensure the device is positioned properly.
- Before you leave the hospital, your doctor and nurse will discuss your medications and when you can return to normal activities. You will be prescribed a medication to prevent blood clots from forming, such as Aspirin for at least six months after the procedure. Your doctor will discuss follow-up and how long he would like you to continue your medications.
- Most children and adults with congenital heart disease should be monitored by a heart specialist and take precautions to prevent endocarditis throughout their life. Check with your doctor if you need to be protected from endocarditis life-long or may discontinue precautions 6 months after your procedure.
What is endocarditis?
Endocarditis occurs when germs (especially bacteria) enter your blood stream and attack the lining of your heart valves, causing growths on the valve, holes in the valve or scarring of the valve tissue, most often resulting in leaky heart valves.
To protect yourself:
- Tell all doctors and dentists you have congenital heart disease. You may want to carry a card with this information.
- Call your doctor if you have symptoms of an infection (sore throat, general body aching, fever). Colds and flues do not cause endocarditis. But infections, which may have the same symptoms, do. So, to be safe, call your doctor.
- Take good care of your teeth and gums to prevent infections. See your dentist for regular visits.
- Take antibiotics before you undergo any procedure that may cause bleeding:
- any dental work (even a basic teeth cleaning)
- invasive tests
- most major or minor surgery
- Check with your doctor about the type and amount of antibiotics you should take.
Please ask your doctor if you have any questions about cardiac implants.
How to find a doctor if you have adult congenital heart disease
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, read more about our Sydell and Arnold Miller Family Heart & Vascular Institute outcomes.
The Center for Adult Congenital Heart Disease in the Sydell and Arnold Miller Family Heart & Vascular Institute is a specialized center involving a multi-disciplinary group of specialists, including cardiologists, cardiac surgeons and nurses from Cardiovascular Medicine, Pediatric Cardiology, Pediatric and Congenital Heart Surgery, Cardiothoracic Surgery, Diagnostic Radiology, Pulmonary, Allergy and Critical Care Medicine, and Transplantation Center, who provide a comprehensive approach to diagnosing and treating adult congenital heart disease.
You may also use our MyConsult second opinion consultation using the Internet.
For younger patients with congenital heart disease:
See: About Us to learn more about the Sydell and Arnold Miller Family Heart & Vascular Institute.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Becoming a Patient
Congenital heart disease is diagnosed by a murmur on a physical exam and several diagnostic tests:
Our webchats and video chats give patients and visitors another opportunity to ask questions and interact with our physicians.
View a calendar of events and register for future chats. Check the calendar for topics that interest you!
Why choose Cleveland Clinic for your care?
Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.
- Darst JR, Collins KK, Miyamoto SDCardiovascular Diseases. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: McGraw-Hill; 2013.
- American Heart Association. About Congenital Heart Defects Accessed 3/12/2015.
- Centers for Disease Control and Prevention. Facts about Congenital Heart Defects Accessed 3/12/2015.
- National Heart, Lung, and Blood Institute. What are Congenital Heart Defects? Accessed 3/12/2015.
- Hirsh JC, Devaney EJ, Ohye RG, Bove EL. Chapter 19B. The Heart: II. Congenital Heart Disease. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 13e. New York, NY: McGraw-Hill; 2010.
- Raissadati A, Nieminen H, Jokinen E, Sairanen H. Progress in late results among pediatric cardiac surgery patients: A population-based 6-decade study with 98% follow-up. Circulation. 2015 Jan 27;131(4):347-53. http://circ.ahajournals.org/content/early/2014/12/23/CIRCULATIONAHA.114.011190.abstract
- Jacobs, ML. Pediatric cardiac surgery: The long view. Circulation. 2015 Jan 27;131(4):328-30. http://circ.ahajournals.org/content/early/2014/12/23/CIRCULATIONAHA.114.014318.abstract
- Born with a Heart Defect? Your Life Span Can Be Normal. Cleveland Clinic Health Hub. May 26, 2015. Accessed June 24, 2015. http://health.clevelandclinic.org/2015/05/born-with-a-heart-defect-your-life-span-can-be-normal/
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