Cardiac Implant Closure Devices in Adults

Overview

Amar Krishnaswamy, MD, FACC

What is a closure device?

Closure devices are used to close a defect 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:

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 catheter is inserted into a vein in the leg and advanced into the heart and through the defect. The device is slowly pushed out of the 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 procedures are monitored by X-ray and an ultrasound camera inserted in the heart from a vein in the top of the leg.

AMPLATZER™ PFO Occluder

AMPLATZER™ PFO Occluder
AMPLATZER and St. Jude Medical are trademarks of St. Jude Medical, LLC or its related companies. Reproduced with permission of St. Jude Medical, ©2017. All rights reserved.*

Gore Cardioform Device for septal closure

Gore Cardioform Device for septal closure
Photo used with permission from of W. L. Gore & Associates*

What if a closure device is not an option?

Patients who are not candidates for catheter based closure devices, may require surgery to close their septal defect. Minimally invasive and robotically assisted approaches are available. Congenital heart cardiologists, interventionalists and surgeons work together to make sure each patient gets the right procedure to treat their congenital heart condition.

Procedure Details

Before the Procedure

Preparing for your procedure

  • 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) or other blood thinners.
  • 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 will not return home the day of your procedure, but most likely the next day. Bring items with you (such as robe, slippers and toothbrush) that may make your stay more comfortable.
  • A responsible adult must drive you home after the procedure. You will not be discharged unless there is someone available to drive you home.

During the Procedure

During the Procedure

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 procedure takes place in the cardiac catheterization (cath) room. This 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.
  • 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 leg. A catheter will be inserted through the sheath and threaded to the heart.

In come cases, the doctor may inject dye in the heart arteries or heart chambers to better understand your condition.

  • 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)
    • Nausea
    • 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.

Very rarely, 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.
  • When the physician is satisfied with placement of the device, it is released from the catheter and placed in your heart to close the defect. 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

What happens after the procedure:

  • The catheters and sheath are removed from your groin. Pressure will be placed on the leg vein. Sometimes a small suture is placed to close the vessel.
  • 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 an 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 baby aspirin lifelong. Very often clopidogrel (Plavix) is also ordered for 6 months. Your doctor will discuss follow-up and how long he would like you to continue your medications.
  • Most 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.

Risks / Benefits

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.

Resources

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 Miller Family Heart, Vascular & Thoracic Institute Outcomes.

The Center for Adult Congenital Heart Disease in the Sydell and Arnold Miller Family Heart, Vascular & Thoracic 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 & Thoracic Institute.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Last reviewed by a Cleveland Clinic medical professional on 04/29/2019.

References

  • Agarwal S, Bajaj NS, Kumbhani DJ, Tuzcu EM, Kapadia SR. Meta-analysis of transcatheter closure versus medical therapy for patent foramen ovale in prevention of recurrent neurological events after presumed paradoxical embolism. JACC Cardiovasc Interv. 2012 Jul;5(7):777-89. doi: 10.1016/j.jcin.2012.02.021.
  • Khan AR, Bin Abdulhak AA, Sheikh MA, Khan S1, Erwin PJ, Tleyjeh I, Khuder S, Eltahawy EA. Device closure of patent foramen ovale versus medical therapy in cryptogenic stroke: a systematic review and meta-analysis.JACC Cardiovasc Interv. 2013 Dec;6(12):1316-23. doi: 10.1016/j.jcin.2013.08.001. Epub 2013 Oct 16.
  • Poddar KL, Nagarajan V, Krishnaswamy A, Bajaj NS, Kumari M, Bdair H, Modi D, Agarwal S, Goel SS, Parashar A, Tuzcu EM, Kapadia SR. Risk of cerebrovascular events in patients with patent foramen ovale and intracardiac devices. JACC Cardiovasc Interv. 2014 Nov;7(11):1221-6. doi: 10.1016/j.jcin.2014.04.025. Epub 2014 Oct 15.

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