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
Aortic erosion following ASD closure
http://content.onlinejacc.org/cgi/content/full/45/8/1213
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