Closure of holes in the heart without surgery
Closure of holes in the heart without surgery. Congenital heart defects change the normal flow of blood through the heart. There are many types of congenital heart defects. They range from simple defects with no symptoms to complex defects with severe, life-threatening symptoms. The most common defects are “Holes in the Heart.
Congenital heart defects change the normal flow of blood through the heart. There are many types of congenital heart defects. They range from simple defects with no symptoms to complex defects with severe, life-threatening symptoms. The most common defects are “Holes in the Heart. Congenital heart defects are the most common type of birth defect. They affect 8 of every 1,000 newborns. Over the past few decades, the diagnosis and treatment of these complex defects has greatly improved. As a result, most of the children who have complex heart defects survive to adulthood and can live active, productive lives.
How does the Heart Work?
To understand congenital heart defects, it's helpful to know how a normal heart works. The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. Then, oxygen-rich blood returns from the lungs to the left side of the heart, and the left side pumps it to the body.
The heart has four chambers and four valves and is connected to various blood vessels. Veins are the blood vessels that carry blood from the body to the heart. Arteries are the blood vessels that carry blood away from the heart to the body. The heart has four chambers or "rooms." The atria are the two upper chambers that collect blood as it comes into the heart. The ventricles are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body.
The Common Holes
The commonest holes are VSD (Ventricular Septal defect), ASD (Atrial Septal Defect) and PDA (Patent Ductus Arteriosus). VSD is a hole in the interventricular septum or wall between two lower chambers (RV and LV). ASD is the name of the hole in interatrial septum and PDA is actually an extra pipe connecting Aorta and Pulmonary Artery.
Of these three, VSDs are the commonest lesion about 25-30% of all congenital heart defects whereas ASD and PDA are about 5-8% of them. Another point to remember is that most of us are born with small ASD and small PDA which closes spontaneously after birth. However, VSD is never found in normal heart.
How will the procedure be done?
Catheter procedures are much easier on patients than surgery because they involve only a needle puncture in the skin where the catheter (thin, flexible tube) is inserted into a vein or an artery. Doctors don't have to surgically open the chest or operate directly on the heart to repair the defect(s). This means that recovery may be easier and quicker. Device closures are usually tried after child has good weight like 6-7 Kg.
We have large vessels in our groin called Femoral Artery and Femoral Vein. A needle is first introduced into these two vessels (something like starting a saline drip). Next cardiac catheters are passed through these vessels and they reach the heart. Meanwhile the intra cardiac pressure and anatomic data from these catheters are collected. A radio contrast will be injected to outline the hole. Simultaneous echocardiography and fluoroscopy is done to confirm the findings.
Then a Nitinol(nickel- titanium alloy) device or button is delivered to the site of the hole and finally it is released. Post procedure angiography and echocardiography is done to confirm everything is OK. Then all catheters are taken out and only the device stays inside the heart. All this is done under general anesthesia so that the baby does not feel anything. Post procedure, baby is taken to the pediatric ICU, slowly taken out of anesthesia and monitored for 24 hours.
Next day, he/ she undergo another echo and discharged home. Preparation of the child before Device Closure The child is admitted the evening before. Some basic investigations like blood tests (hemogram, urea, creatinine, and serology); Chest X Ray and ECG are done. An anesthesist checks the baby for fitness and starts saline. The child has to fast for a minimum of four hours before the procedure.
Post Device Closure:
What to Expect?
Your child will be in pediatric ICU till he is conscious, breathing normally, blood pressure and heart rate stabilizes and he is able to take oral feeds. Usually this takes 4-6 hours but may vary from child to child. There will be a bandage covering the groin. Echocardiography is being done next day. The baby is started on medicines to prevent clot inside the heart. This is called Aspirin and given once daily for 3-6months. These three months are the time taken for the heart to develop endothelium lining around the device so that the device becomes a part of the body.
Atrial Septal defect: When to Close an ASD?
a. When the size of hole is more than 5-8mm
b. Right Heart Enlargement
c. High Lung Pressures
d. Recurrent Pneumonias, Poor Weight Gain
Only ASDs in central portion of interatrial septum (Secundum ASD or FOSSA OVALIS ASD) can be closed by device. ASDs in topmost or lowest portion of the interatrial septum can be closed only surgically.
Ventrical Septal Defect (VSD Device Closure):
VSD is the commonest congenital heart disease. Percutaneous device closures of VSDs are still under evolution. Muscular VSDs or Holes in the muscular partition between right and left ventricles are easily closed by devices. However VSDs which are situated close to the cardiac valves (like aortic and tricuspid) are better closed surgically.
Poor weight gain, repeated pneumonias
VSD with left hear enlargement
VSD with high lung pressures
Left to right shunt ratio >2:1
Patent Ductus Arteriosus (PDA Device Closure)
PDAs are found in 6-8% of children with heart disease. Unlike ASD or VSD, all PDAs are now closed non-surgically be device closure. Smaller PDAs like <2.5mm in size are closed by coils. The decision whether coils or device is taken inside the cath lab. Both have excellent results, reported success rates is 98-99%. Only premature newborns with very large PDAs causing heart failure are closed by surgery.
Advantages with device closure procedure
1. Device closures of Holes in Heart Is Effective, Safe and Time Tested Procedure.
2. It is painless and scars less and allows your child to resume normal life including school within 3 days.
3. Compared with the open heart surgical procedure this is cost effective too.