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Closure of ASD
In the womb, a normal human heart has a hole in the middle.
More specifically, the "hole" is an open space in the atrial septum. This space allows blood to move thru the heart without going to the baby's lungs.
When a baby takes his or her first breath, the defect in the atrial septum usually closes. This is true for ~75% of people.
About 25% of people have a defect that does not close. This is called a Patent Foramen Ovale aka PFO.
A PFO does not generally cause problems. Most patients with a PFO do not know they have one.
However, it is possible for a blood clot to move from the veins across a PFO into the left side of the heart. This can lead to a stroke.
If a patient, especially a young patient, has a stroke and is found to have a PFO, the patient may be started on a blood thinner and may have the PFO closed.
A PFO can sometimes be closed with a device placed percutaneously, or thru the skin. A catheter is used to move an umbrella-like device into the PFO. The device is then deployed and used to plug the hole.
Sometimes a PFO is in a location within the heart where a catheter device will not work. In these cases, closure with a surgical approach can be considered.
An ASD is a bit like a PFO. An ASD is an Atrial Septal Defect. The main difference is that and ASD is not an incomplete closure of atrial tissue like a PFO but rather an absence of tissue to close.
Generally, an ASD is larger than a PFO. An ASD may be so large that a large amount of blood flows abnormally, making a patient short of breath.
An ASD can sometimes be closed with a percutaneous device and sometimes can be closed with an operation.
If an operation is needed for a PFO or an ASD, there are a couple of options in terms of how to perform the operation:
STERNOTOMY
MINIMALLY-INVASIVE
A sternotomy can be used to perform closure of an ASD (or PFO).
The patient is put to sleep with a general anesthetic.
An incision is made thru the breast-bone and the heart is exposed.
Once the heart is stopped, an incision is made to access the ASD.
The ASD can be closed with suture or with a patch. The patch can be made from the patient's pericardium or from special medical fabric (Dacron).
The heart and lung machine is used, so that the heart can be stopped.
Patients are usually in the hospital 4-5 days after a sternotomy.
A minimally-invasive method can often be used for closure of ASD.
The patient is put to sleep with a general anesthetic.
A minimally-invasive approach usually takes 1-2 hours to perform.
Dr. Pool has done many ASD closures with a minimally-invasive approach.
An incision is made in the right chest, between the ribs. The breastbone is not cut.
A small incision is also made in the groin.
Patients are usually in the hospital 4-5 days after a minimally-invasive closure of ASD.
The heart and lung machine is used, the heart is stopped, and the defect is closed.
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