Atrial septal defect is one among the commonest congenital heart disease .After years of controversy, there is consensus now , all significant ASDs need to be closed , at whatever age it is detected.
This rule does not apply to small ASDs without chamber right atrial and right ventricular dilatation. These defects and PFOs need not be closed .
Over the years , the controversy has shifted from Should we close ? to How to close ?
There are two options available : Device closure , Surgical closure
The following table compares the both treatment modalities
( Personal perspective )
Final message
Device closure is a complex, costly, often difficult and error prone cardiac procedure .It needs long term follow up and may carry a life long risk of major cardiac complication.It is useful only in selected subset of ASD patients. Surgical closure prevails over device closure in most situations.
Is this article has biased view against this emerging pediatric interventional procedure of ASD closure ?
It may appear so . But that is the reality as on 2009 !.May we hope technology evolves further and take our surgeons head on .
2012 update on ASD device closure .
The hard-ware as well as the expertise has improved a lot and it is on right track to become a real challenge to surgery.
The only issue again is the availability of rims to mount the device . Another realistic and sensitive issue which have I come across is , many interventionist cardiologist do feel awkward when they experience unexpected rim shortage on table. They should realise it is not their fault.
Always be ready to abandon the procedure and refer to the surgeon , according to your true conscience
After all , improperly delivered device is a life long pain for the patient .He has come to you with a great belief isn’t !
2014 update
Device closure for most ASDs in both children and adult is now possible with high degree of success. We have crossed about 50 patient experience. And I am truly amazed , how within a short period the device closure is about to conquer the crown from the surgeons ! (Exciting new data are coming from my colleague Dr Gnanavelu from the new Super specialty hospital of Government of Tamil Nadu Chennai. )
Reference
The final message in the above article seems very misleading.
” that is the reality as on 2009″
Is that the reality in 2009?
The above article is based on a report in the Journal of the American Colledge of Cardiology based on an ASD closure done in March 2002.
Are there any more updated reports?
Thank you for your comments,
I agree , but things have not greatly changed in the last 5 years.
The device technology is still evolving , while the surgical methods are fully evolved with proven efficacy and the complications are less and if at all it occurs , it is during the surgery and perioperative phase.
In contrast , the ASD device closure , the complications are still being reported .The major uncertainity is the device mismatch with ASD rim .Exact matching is very difficult to accomplish .As the child grows , the effect of mechanical stretch on the IAS by the device is unknown.
The device , if larger can have constant friction over the adjacent aorta. This , need to be monitored .
All these factors make this procedure ( Personal opinion) less ideal.
In future , glued biological tissues , delivered through catheters may be the answer for some these issues.
let us wait . . . before concluding !
Dr .S.Venkatesan
Hi Dr. Venkatesan,
I got my Amplatzer recently, 4 Oct 2010. I´m 46 years. My ASD was very large (38 mm!!). I was happy right now, but all this news are very disturber to me…¿Which is the failure percentage today? ¿What shall me happen in the future? (sorry by my english, I live in South America)
Hi
The fact that you are comfortable implies your device is safe.
Do not unduly worry about the futture of your device.
My article is not against the device closure.I have just compared the two .
At this point of time you need regular follow up .That’s It.
Be confident, you will live a long and healthy life.
Dr Venkatesan Chenai .India
New safety information on ASD closure device
Now multiple perforations are reported
See the dramatic images from HEART
http://203.199.194.78:2429/content/96/19/1603.full
Hi Dr. Venkatesan,
I got my Amplatzer in Dec 2005. I was 42 at the time and am thankfully 45 now! They determined that my ASD was of the size that it needed the largest device they made – about the size of a half dollar. My right side of my heart was already enlarged. They guaranteed me (verbally) that I would not feel it but I have almost always felt it.
I am in reasonable shape. I am 5’4 and weigh 157 pounds. My mother died of a misdiagnosed heart attack at 64.
The first six months I stayed in touch – I reported sharp pains and they had me wear a heart monitor for a month and they saw nothing of concern. I asked for a stress test and they said I was fine.
I still have heart palps and sometimes sharp pain…this last week or so I have had a constant heart straining sensation with some increased heart rate. I tend to rub my sternum now to try to calm the feeling.
I went last year to urgent care for heart pain – they took me by ambulance to the ER – they did an ekg and found nothing…
Bottom line is that I have always felt that something wasn’t quite right about the device and them releasing me to normal life with no real follow up – especially when I told them how I felt and they told me I did not feel the way I did.
Do you have any suggestions about what I should do to make sure I get treated for potential effects of the device?
Is it possible I have hypertension? I have great blood pressure but high trigs and cholesterol.
Thank you so much for this blog, it makes me feel like I am not alone.
Roxie
Sir,
Thanks for your valuable insights. I am interested to know if you have come across problems for kids whose ASD is < 10 mm stretched size.
Thanks
Badri
Dear Dr. Venkatesan,
Thank you for your hard work and for this blog. I am currently working on a paper that addresses the issue of long-term complications ASD closure devices. Currently, I am having difficulty finding literature on the safety and efficacy of surgical closures since only relatively few are being performed these days. I would be very greatful for any assistance. Thank you for your time.
Zach