Successful Transcutaneous Closure of Atrial Septal Defect
[ Congenital Heart Disease ]

Dr. Bharat Dalvi, Dr. Rita Dixit

Department Of Cardiac Surgery[A Nanavati Hospital ]

The human heart is normally made up of 4 chambers ; 2 upper chambers [ ATRIA] and 2 lower chambers [ VENTRICLES]. These chambers are divided by Septum into left and right chambers. When the partition [SEPTUM] between the 2 upper chambers is deficient, it results in an Atrial Septal Defect [ Hole in the Heart ]

For years, the only way to mend this defect was by open heart surgery which is undoubtedly safe, but recent advances in medical technology has enabled us to close these holes without surgery.

CASE :
A 12 years old healthy boy was found to have a murmur [ abnormal heart sound] at a routine school health check-up. The parents were worried about he condition and approached Dr. Bharat Dalvi. Simple non invasive tests like a chest X-ray , 2D-Echo were carried out after a through clinical examination and diagnosis of A. S. D. was made [ Ostium Secundum with L - > R shunt]

The parents were reluctant for an open heart surgery. Dr. Bharat Dalvi gave them a safe efficacious option in the form of Transcutaneous umbrella closure of ASD.

The patient was optimized and taken in the Nanavati – Cath Lab for the closure. The procedure was done under local anesthesia and lasted for about 1.5hrs. Catheters [ small tubes] were advanced to the area of defect in the heart from his groin [ without cut] which contained the AMPLATZER [ umbrella] device. These devices are made up of an alloy called NITINOL. It is a Biocompatible alloy with MEMORY [ Takes original shape at body temperature]. These characteristics make it most suitable for the procedure . At the area of the defect the umbrella [ device] was delivered in a controlled fashion without damaging the surrounding structures.

The design of the device is such that if the we is sub optimal then , it can be retrieved and repositioned until optimal positioning is obtained.
After the procedure patient was transferred to the ward discharged next day.
She was prescribed Baby Aspirin pills for 6 months.

CONCLUSION :
Surgical closure of ASD is now done only for failed device closures or in cases where device closures are not possible.

Device closure of ASD is safe and efficacious short and intermediate term results are gratifying.