An atrial septal defect (ASD) is an abnormal hole between the two top chambers of the heart (atria) usually present since birth. It is a form of congenital heart disease. The size of the hole can vary. Blood passing through the hole causes additional stress on particularly the right hand side of the heart and can eventually lead to heart failure if left untreated.
The ASD may be detected by your doctor hearing a heart murmur or by performing a trans-thoracic echocardiogram, but will usually be confirmed with a trans-oesophageal echocardiogram. Closure of the ASD may be recommended to reduce the chance of heart failure. This can be performed either with open heart surgery or with keyhole techniques if the defect is suitable.
The keyhole procedure is usually performed under a general anaesthetic. A tube (catheter) is inserted into the vein at the top of the leg (femoral vein). It is then passed across the ASD. A double-umbrella device is then passed through the catheter and released so that it straddles the defect and closes it.
Usually ASD closure requires an overnight stay in hospital. Blood thinning medications are used after the procedure until tissue grows over the closure device. Usually aspirin is recommended for 6 months and clopidogrel for the first 3 months. The closure device should be protected against infection particularly in the first 6 months by taking a dose of antibiotics 30-60 minutes before at-risk procedures such as dental work or other surgery. Heavy exertion should be avoided for the first month. Follow-up transthoracic echocardiography is usually performed at 1 month, 6 months then annually.