ASD Closure (Atrial Septal Defect Closure)

What is Atrial Septal Defect (ASD)?

Atrial Septal Defect (ASD) is a congenital heart disease characterized by an abnormal opening in the wall between the left and right atria of the heart. Often referred to as a “hole in the heart,” ASDs can vary in size and may close on their own or require intervention.

Natural Course

• Small ASDs may close by college age
• Medium-sized ASDs may go unnoticed until middle age
• Large ASDs can cause symptoms earlier in life

Signs and Symptoms of ASD

• Heart murmur
• Breathlessness
• Fatigue
• Poor appetite
• Heart palpitations
• Decreased exercise capacity
• Cyanosis (bluish discoloration)

Diagnosis and Tests

• Physical Evaluation: Detection of heart murmur
• Chest X-ray: Shows an enlarged heart
• Echocardiogram: Visualizes blood flow and defect size
• Electrocardiogram (ECG): Detects arrhythmias

Treatment Options for ASD Closure

Treatment depends on the size and location of the defect.

Open Surgery

• Performed under general anesthesia with a heart-lung machine
• ASD is approached via the right atrium
• Closed using a patch or sutures

Minimally Invasive Surgery

• 4–6 cm chest incision without splitting the breastbone
• Uses specialized instruments and an endoscope
• Faster recovery and minimal scarring

After Surgical Repair

• Hospitalization: 3–4 days
• Tenderness, numbness, and tightness around the incision
• Initial days of rest at home
• Chest incision heals in ~6 weeks

ASD Closure Procedure (Catheter-Based)

Before Procedure

• Medical history and clinical evaluation
• Fitness tests and counseling

During Procedure

• Done in cardiac catheterization lab
• Catheter inserted via femoral vein to the heart
• Closure device with two discs deployed across the defect
• Guided with fluoroscopy (X-ray imaging)

After Procedure

• Overnight monitoring in hospital
• Discharged next day on antibiotics
• Blood thinners to prevent clot formation
• Physical activity restrictions temporarily
• Regular follow-up and imaging

Complications of ASD Closure

• Bleeding
• Infection
• Device displacement
• Transient arrhythmia
• Allergic reactions
• Blood clot formation

Prognosis

• Excellent long-term outlook
• Most do not need further surgeries
• Continued follow-up with echocardiography and ECG is essential

Frequently Asked Questions

Q: Is the Diagnosis of ASD Fatal?
A: No, ASDs are among the most benign heart defects.

Q: What Are the Types of ASD?
A:

• Ostium secundum (most common)
• Ostium primum
• Sinus venosus
• Coronary sinus

Q: What Are the Causes of ASD?
A: Often unknown; genetic factors may play a role.

Q: What Are the Long-term Complications of ASD?
A:

• Pulmonary hypertension
• Atrial arrhythmia
• Right-sided heart failure
• Stroke

Q: Is Atrial Septal Defect Life-threatening?
A: Small ASDs may be harmless; large ones can be dangerous.

Q: When Can the Catheter Technique Not Be Used?
A:

• Large or unusually located ASDs
• Presence of other related heart defects