Atrial Septal Defect

The defect can be closed percutaneously by inserting a device through the blood vessels in the groin (percutaneous transcatheter approach) or via surgical repair. The choice of treatment depends on the size of the defect and the presence of pulmonary hypertension. After the defect is closed, the patient will need regular follow up with a cardiologist.

Device Closure for Atrial Septal Defect (ASD)

The procedure usually takes between 1 and 2 hours and the success rate is about 95%. However, there are known risks involved. The risks and their estimated incidence of occurrence are:

• Device dislodgement (embolisation) and the need for emergency heart surgery: 1%
• Device erosion (device eroding through the heart walls): 0.3%
• Death: less than 1% (usually from perforation of the heart chamber)
• Dislodgement of clot or air bubbles to the brain (causing stroke) and other organs:  less than 1%
• Rhythm disturbance (arrhythmia) (usually transient): 1 to 2%
• Other potential risks: Allergic dye reaction, anaesthetic reaction, bleeding and bruising around the sheaths in the groin, injury to the artery/vein/nerves in the groin, perforation of the oesophagus (from the TEE probe), headache or migraine, infection, allergic reaction to the nickel component of the device

Patients with small Atrial Septal Defect (ASD) seldom develop any complications. However patients with moderate- to large-sized defects may develop irregular heart rhythm, heart pump failure and high pressure in the lung. These patients may need additional medications to treat these complications.

Some of these complications, if they do occur, are of a serious nature and may require further treatment including surgery and prolonged hospitalisation. In the event of device dislodgement, you may require surgery for removal of the device and closure of the hole at the same time.

Not all types of Atrial Septal Defect (ASD) are suitable for device closure. You will need to have a detailed echocardiogram scan including both transthoracic echocardiogram as well as a transoesophageal echocardiogram to assess if your defect is suitable for closure. Defects which do not have sufficient rims for the device to sit safely, are too near to other heart structures such as veins, valves and very large (more than 3.6cm) may not be suitable for device closure and may be better treated with surgery.