Atrial septal defect (ASD) closure

An ASD closure is a procedure to close an atrial septal defect (ASD). ASD occurs when part of the septum, the tissue that separates your upper two heart chambers (atria), doesn’t form properly. This causes a hole in your heart that doesn’t close on its own.

Specialists in Penn Medicine’s Interventional Cardiology Program close an atrial septal defect with a minimally invasive technique called cardiac catheterization. They use a thin, hollow tube (catheter) inserted in the groin and threaded up to the heart to place an ASD closure device that plugs the hole. This approach is also called transcatheter ASD closure.

Our cardiologists offer minimally invasive structural heart disease treatments to close atrial septal defects (ASDs) without opening your chest for surgery.

Most people with ASDs are candidates for catheter-based closure. If you have a large hole or other heart defects along with an ASD, your cardiologist may recommend an open-chest ASD closure. In these procedures, a cardiac surgeon opens your chest and uses the device, stitches, or a patch to repair the hole.

Your care team will give you specific instructions to prepare for an ASD closure. They may instruct you to stop taking certain medications, such as blood thinners, for a short period before the procedure. You’ll need to stop eating or drinking around midnight on the day before an ASD closure.

You may have a few tests before the procedure to evaluate your heart and provide clear images of the ASD to guide the repair:

• Chest X-ray to look at your heart’s structure
• Doppler ultrasound to assess how blood flows through your heart
• Echocardiogram to look at your heart’s anatomy and blood flow
• Electrocardiogram to check your heart rhythm

ASD closure is an inpatient procedure performed in a catheterization lab while you receive sedation to keep you calm and comfortable. An interventional cardiologist and an interventional echocardiographer work together to perform the procedure.

During a minimally invasive ASD closure, an interventional cardiologist:

1. Makes a tiny puncture in your groin and inserts a hollow plastic tube called a sheath into a blood vessel
2. Inserts a catheter with a closure device through the sheath
3. Uses X-ray and echocardiogram imaging to guide the catheter to your heart
4. Takes several measurements to evaluate the blood pressure and oxygen levels in your heart
5. Places the closure device in the hole in your heart

The ASD closure device is designed to flatten against your septum and seal the hole. Immediately after surgery, the device stays in place because of the natural pressure in your heart. Over time, your heart tissue grows around the ASD closure device.

You usually spend one night in the hospital before returning home. Most people return to usual activities around one week after a catheter-based ASD closure. Your cardiologist may prescribe aspirin to prevent clots or antibiotics to prevent infections. You usually need to take these medications for several months.

Closing an ASD helps improve your heart function and reduces your risk of complications associated with ASD, which can include heart failure and stroke. Without treatment, an ASD may allow excess blood to leak into the lungs, causing lung damage.

Because catheter-based ASD closure doesn’t require a large incision, the procedure offers significant benefits. Patients typically recover more quickly than from open-heart surgery, spending less time in the hospital and experiencing fewer complications. Our patients also report less pain following catheter-based procedures.

ASD closure complications

ASD closures are safe procedures without the risks of open-chest surgery. The chances of complications associated with a transcatheter ASD closure are lower than the chances of surgical ASD closure complications. Complications are rare, but can include:

• Bleeding
• Irregular heart rhythms (arrhythmia)
• Infection around the closure device or the incision
• Kidney failure
• Stroke or transient ischemic attack (TIA)

Penn interventional cardiologists have a long history of innovation and excellence in structural heart disease treatments. You benefit from:

• Clinical trials: Penn cardiologists have been involved in clinical trials for decades, continually incorporating the newest treatment options into their practice. Thanks to our research, our team can offer more treatments for ASDs than many other centers. For example, we can use a stent to close an ASD, an option not available elsewhere in the region.
• Team-based care: Your treatment team includes the expertise of a specialized interventional cardiologist and interventional echocardiographer. We work closely with cardiac surgeons to offer the full range of ASD treatments. Thanks to our specialized team, you never have to venture outside Penn for leading-edge care.
• State-of-the-art technology: We perform ASD closures in our state-of-the-art imaging and catheterization laboratory (cath lab). The lab houses the latest technology, including imaging that allows us to perform heart procedures with exceptional visualization and precision.