What are my treatment options?
Treatment for patients with an ASD depends on the type and size of the defect, its effect on the heart, and other health conditions you have, such as pulmonary hypertension, valve disease or coronary artery disease.
In general, treatment is recommended if you have a large ASD that causes significant shunting (flow of blood through the defect) and the right side of your heart is bigger than normal, or you have any of the symptoms described previously.
The bigger the defect is, the more shunting you have. And, the more shunting you have, the bigger your risk of problems like atrial fibrillation and pulmonary hypertension. Also, the amount of shunting you have usually relates to how enlarged the right side of your heart is.
The amount of shunting is measured using echocardiography, MRI or catheterization.
Nonsurgical (percutaneous) repair is the preferred treatment for most patients with secundum ASDs. If you have a different type of ASD, or the anatomy of your secundum ASD is not amenable to percutaneous closure, you may need surgery. Your doctor will let you know which type of repair is best for you.
This type of repair uses a device to close the hole in the septum.
Two different brands of closure devices are approved by the U.S. Food and Drug Administration for percutaneous ASD closure — the Amplatzer® Septal Occluder and the GORE HELEX® Septal Occluder.
The designs of the devices are different, but they work in similar ways.
The device is put in place using a long, thin tube called a catheter. The device is attached to the catheter, which is guided to your heart through a vein in your groin. When the device is released from the catheter, it opens up and seals the hole. Over time, tissue grows over the implant and it becomes part of the heart.
If your doctor recommends this type of repair, you will have a cardiac catheterization to check the size and location of the defect and measure pressures in your heart.
After the procedure, you will need to take a blood-thinning medication to keep clots from forming on the device. Your doctor will talk to you about the right type of medication for you and how long you need to take it.
Percutaneous Closure Devices for ASD Repair
AMPLATZER® Septal Occluder
The AMPLATZER® Septal Occluder is a transcatheter closure device used to treat ASDs. It consists of two Nitinol wire mesh discs filled with polyester fabric. It is folded into a special delivery catheter, similar to the catheter used to cross the heart defect during catheterization.
The catheter is inserted into a vein in the leg, advanced into the atrial septum and through the defect. When the catheter is in the proper position, the device slowly is pushed out of the catheter until the discs of the device sit on each side of the defect, like a sandwich. The two discs are linked together by a short connecting waist that matches the size of the defect. The discs and the waist are filled with polyester fabric to increase the device’s closing ability. Over time, heart tissue grows over the implant, and it becomes part of the heart, permanently correcting the defect.
AMPLATZER® device used for ASD repair (Photo used with permission from W.L. Gore & Associates, Inc.)
GORE HELEX® Septal Occluder
The GORE HELEX® Septal Occluder is a disc-like device that consists of ePTFE patch material supported by a single Nitinol wire frame. The device is put in place with a catheter and slowly pushed out until it covers the defect. The device bridges the septal defect.
GORE HELEX® Septal Occluder used for ASD repair (Photo used with permission from W.L. Gore & Associates, Inc.)
Surgery may be needed to repair large secundum ASDs and other types of ASDs. In some cases, this can be done robotically or with a small incision.
Surgical repair usually involves using a tissue patch to close the ASD. The tissue often comes from your own pericardium (membrane around the heart). Some secundum ASDs can be surgically closed with sutures alone.
Your doctor will let you know how often you need to be seen for follow-up visits. A typical schedule is 3, 6 and 12 months after your procedure and once a year after that.
Your doctor will talk to you about activity restrictions related to recovery from the procedure.
Expect to take blood thinners for 6 to 12 months after surgery.
If you had a stroke, you may need to take this medication indefinitely. If you have another heart condition, you may need to take other medications.
You may need to take antibiotics before certain medical procedures for at least 6 months after your procedure to prevent an infection of your heart’s lining (endocarditis).