Percutaneous Closure of Hole in the Heart – Case by Dr. Krupal Reddy


Atrial Septal Defect (ASD) is a defect that exists between the two upper heart chambers (the atria). This defect allows mixing of oxygenated and deoxygenated blood, eventually causing right heart enlargement and high pressure in the lungs (pulmonary hypertension).

If undetected in childhood, symptoms can develop gradually over decades. Common presenting symptoms include dyspnoea, easy fatigability, palpitations, sustained atrial arrhythmia, syncope, stroke, and/or heart failure.

Moderate to large sized ASD causing right heart dilatation and raised pressure in the lungs should be closed and closure can be performed either through open heart surgery or percutaneously (through the femoral vein) using advanced interventional techniques and septal occluder device (fig. 1 & fig. 2).

The procedure involves inserting a small tube, called a catheter or sheath over a guide wire through the femoral vein to the procedure site within the heart. The device is passed through the catheter and deployed across ASD to seal the hole.

FIG. 1– SEPTAL OCCLUDER DEVISE FIG. 2 – ASD DEVICE CLOSURE

A 35-year-old female, hailing from Rajasthan, was presented with intermittent palpitation and dyspnoea on exertion. She underwent echocardiography at a different centre and was diagnosed with ASD and was advised surgical closure of ASD. Then she came to SevenHills Hospital for a second opinion, where Dr. Krupal Reddy, one of the main Consultant Interventional Cardiologists of SevenHills Hospital, examined her. He also performed TEE (Trans Oesophageal Echo) - an advanced imaging technique - to assess the ASD (fig. 4). After that, the decision was taken to close ASD percutaneously i.e. without open heart surgery.

FIG. 3 – TRANS THORASIC ECHOES SHOWING ASD FIG. 4 – TEE – TRANSESOPHGEAL ECHO SHOWING ASD

The procedure was successfully performed by Dr. Krupal, under local anaesthesia. The duration of procedure was only 45 minutes. ASD was completely closed without any residual flow (fig. 5). Patient was discharged on 3rd day of procedure and is doing absolutely fine on follow up.


FIG. 5 - ECHO SHOWING SEPTAL OCCLUDER DEVICE ACROSS THE ASD

“This case was not a completely straightforward case as one of the rim surrounding the ASD was deficient. But using various interventional techniques it was successfully closed percutaneously”– said Dr. Krupal Reddy, D.M. M.D. Interventional Cardiologist.

The advantage of percutaneous technique over the surgical technique is no surgical scar, less invasive procedure compared to surgery, generally done under local anaesthesia (depends on complexity of defect), reduced duration of hospital stay and results almost equal to surgical closure in rightly selected cases.