chapter  7
20 Pages

Technique of percutaneous closure of the atrial septal defect and patent foramen ovale Kevin P Walsh and Anita Dumitrescu

INTRODUCTION Percutaneous atrial septal defect (ASD) closure is now a routine procedure in many cardiac catheterization laboratories. It has replaced surgery as the method of choice for ASD closure in most patients. The successful percutaneous closure of an ASD requires careful echocardiographic evaluation of the defect, precise device selection, and meticulous implantation technique. Operator experience is a significant factor, as the inexperienced operator will tend to reject potentially suitable patients and oversize devices, which represents a form of false security. It is therefore important that any operator/team have sufficient throughput to develop and maintain skills. It must also be borne in mind, that although transcatheter closure of the patent foramen ovale (PFO)1-4 is likely to become an extremely common procedure, the experience gained with PFO closure is unlikely to qualify the operator to close the occasional large atrial septal defect.

PREPARATION Patients who undergo interventional ASD closure are usually scheduled for a three-day hospital stay. The admission day involves routine blood tests, to rule out coagulation disorders, chest radiograph, ECG (electrocardiogram) and occasionally repeat transthoracic echocardiography (TTE). The interventional cardiac catheterization is performed on the second day, and the patient is discharged on the third day after prior assessment of correct device position and efficacy of defect closure via TTE and chest radiograph.