implantable closure device

overview

An implantable closure device is used to treat heart conditions like atrial septal defect (ASD), a congenital heart defect (meaning, something you are born with). An ASD is a small hole in the tissue (atrial septum) that separates the two upper chambers of the heart (the right and left atria). There are several types of ASDs, classified by where in your atria they happen and how big they are. 

An ASD may go unnoticed for years, not causing you any problems, or showing only mild signs. But the symptoms can get a lot worse as you age, and if untreated, you could end up with symptoms of heart failure such as shortness of breath, fatigue or pulmonary hypertension. Patients with ASDs are also at risk for stroke or other problems.

If your doctor feels that your ASD is causing problems, one way it can be treated is to bring a closure device to the spot. (Surgery is another option.) The closure device will help seal or close the hole in your heart by using what looks like two small mesh umbrellas. The device is attached to a special catheter, which is inserted into a vein in your leg and then threaded up to your heart. Using ultrasound, your doctor finds the hole and uses the closure device to seal it. Over time, heart tissue around the hole grows into the mesh of the device and the implant becomes a permanent part of your heart.

evaluation

Your doctor will perform tests to determine if you can be treated with an ASD or if you need surgery. Tests include a cardiac catheterization, echocardiogram and EKG, among others.

If you and your doctor decide on a closure device, he or she will ask you to stop taking any blood thinners you might be on, and possibly other medications, too. 

When you arrive for your appointment, tell the nurse if you have been taking blood thinners, water pills (diuretics) or insulin, and bring any medications with you. Also tell the staff if you are allergic to anything, especially X-ray dye, penicillin-type medications and latex or rubber.

what to expect

Depending on the time of your procedure, you may be asked not to eat or drink anything after midnight the night before.

You’ll be asked to arrive up to 3 hours before you scheduled procedure time. You may get blood drawn and an IV line placed in your arm so you can start getting fluids to protect kidney function. You may have an EKG or chest X-ray done. Staff will likely clip or shave some of your body hair in the area the doctor will be working on. 

An ASD closure procedure usually takes an hour, but you should plan to stay overnight. You’ll be taken into the cath lab, where you’ll lie on a narrow table, with safety straps to keep you in place. Then EKG patches will be attached to your chest to check your heartbeat during the procedure. 

You may be put under for this procedure, so you will be asleep. A tube will be placed down your throat so your doctor can use a machine called a transesophageal echo to take pictures of your heart. X-rays will also be taken, and your doctor will be able to see these images on a several TV monitors hung above the procedure table. After numbing your groin, your doctor will place a sheath, like a long IV needle, into the vein in your leg. 

Next, a catheter is inserted through the sheath, moved up to the atrial septum in the heart, and pushed through the ASD hole. When the catheter is in the right position, the device is slowly pushed out of the catheter until a small disc sits on each side of the defect, like a sandwich. The discs are filled with polyester fabric to increase the device’s closing ability.

recovery

The day after your procedure, you’ll have another echocardiogram done, and will likely be allowed to go home. You’ll be given a follow-up appointment for 6 weeks, and will get instructions on how to care for yourself, such as some restrictions on normal activities.   

Some of the risks associated with this procedure include bruising, sore throat, chest pain, palpitations, stroke, bleeding, infection and death. Your doctor will go over the risks and benefits of the procedure with you in more detail.

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