How Do You Close an Atrial Septal Defect (ASD)?

An atrial septal defect is a hole between the left and right atria.

To close an ASD a patient is placed under General Anaesthesia to protect their airway with a breathing tube.  This is done so that they may remain on their back while an ultrasound probe is passed down their gullet (transesophageal echo, TOE) to provide close-up images of the heart to direct the procedure.

Access to the right side of the heart is gained by inserting a tube under local anaesthetic into the femoral vein, located at the top of the leg at the level of the skin fold of the hip.  The tube is passed up to the right atrium and then through the ASD into the left atrium.  Once it is exchanged for a sizing balloon which is inflated to occlude the hole.  The size of the waist of the balloon is then measured and used to choose the appropriate device size.  Once that is done the balloon is exchanged for a delivery tube.  The chosen ASD device is then delivered up the tube to the heart.  Once the left atrial disc has emerged from the end of the tube, the tube is withdrawn until the device is gently resting on the wall between the left and right atria.  The second disc is then unveiled in the right atrium, so that one disc is firmly on either side of the wall, holding it in place.  Once the position is confirmed on the TOE images the device is released from the delivery cable. and the tube is removed from the leg.  The procedure to deliver the device typically takes about five minutes.

Over the next six months, the patient’s cells heal over the device incorporating it into the wall of the heart.

Dr McGaw has expertise in this procedure.