Heart Hole Closure - ASD, VSD and PFO Treatment

Heart hole closure involves catheter-based treatment of congenital heart defects.

What is a Heart Hole?

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Heart holes are openings in the walls (septum) between heart chambers. These openings may be present from birth or develop later due to conditions such as heart attack.

Types of Heart Holes:

Normal Heart Anatomy

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        ┌─────────────────┐
        │   Left Atrium   │
        │      (LA)       │
        ├────────┬────────┤
        │   ▼    │   ▼    │
        │  Left  │  Right │
        │Ventricle│Ventricle│
        │  (LV)  │  (RV)  │
        └────────┴────────┘
              │
         Septum (Wall)

In Defects:

• ASD: Opening between LA-RA
• VSD: Opening between LV-RV
• PFO: Fetal opening between LA-RA

Atrial Septal Defect (ASD)

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What is ASD?

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ASD is a hole in the wall between the two atria of the heart. It accounts for 10-15% of congenital heart diseases.

ASD Types

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Secundum ASD:

• Most common type
• Located in fossa ovalis region
• Most suitable for catheter closure

ASD Symptoms

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In Childhood:

• Usually asymptomatic
• Frequent respiratory infections
• Growth retardation (severe cases)

In Adulthood:

• Exercise intolerance
• Palpitations (atrial fibrillation)
• Shortness of breath
• Fatigue
• Paradoxical embolism risk

ASD Complications

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If untreated:

• Pulmonary hypertension
• Right heart failure
• Atrial fibrillation/flutter
• Paradoxical embolism (stroke)
• Eisenmenger syndrome (advanced stage)

ASD Diagnosis

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Echocardiography:

• Transthoracic (TTE): Initial assessment
• Transesophageal (TEE): Detailed anatomy
• Defect size and location
• Rim assessment

ASD Closure Criteria:

• Defect diameter: 5-38 mm
• Adequate rim: ≥5 mm
• Qp/Qs >1.5 (significant shunt)

Ventricular Septal Defect (VSD)

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What is VSD?

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VSD is a hole in the wall between the two ventricles of the heart. It is the most common congenital heart anomaly.

VSD Types

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VSD Symptoms

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Small VSD:

• Asymptomatic
• Murmur only

Medium-Large VSD:

• Feeding difficulties
• Sweating
• Frequent respiratory infections
• Growth retardation
• Heart failure

VSD Treatment Indications

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• Qp/Qs >1.5
• Left ventricular dilation
• Signs of heart failure
• History of infective endocarditis

Patent Foramen Ovale (PFO)

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What is PFO?

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PFO is an unclosed fetal passage between the atria that should close after birth but remains open.

Epidemiology:

• Present in 25% of general population
• Mostly asymptomatic
• 40-50% frequency in cryptogenic stroke

PFO and Stroke Relationship

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Paradoxical Embolism Mechanism:

Leg Veins → DVT
        ↓
   Right Atrium
        ↓
   PFO (open passage)
        ↓
   Left Atrium
        ↓
   Brain → STROKE

High-Risk PFO Features:

• Large PFO (>2 mm)
• Atrial septal aneurysm
• Significant right-to-left shunt
• Hypermobile septum

PFO Closure Indications

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Definite Indications:

• Cryptogenic stroke + PFO
• Age <60
• Other stroke causes excluded
• High RoPE score

RoPE (Risk of Paradoxical Embolism) Score:

RoPE ≥7: PFO closure recommended

PFO and Migraine

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• Association between migraine with aura and PFO
• Improvement in some patients after closure
• Not a routine indication

Catheter-Based Closure Procedure

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Pre-Procedure Preparation

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Assessment:

• Transesophageal echocardiography (TEE)
• Defect size and anatomy
• Rim assessment
• Pulmonary pressure measurement

Patient Preparation:

• Fasting (6-8 hours)
• Medication review
• Antibiotic prophylaxis

Closure Devices

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ASD/PFO Occluder Devices:

VSD Occluder:

• Amplatzer VSD Occluder
• Muscular and perimembranous types

Procedure Technique

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Steps:

1. Femoral vein puncture (groin)
2. Right heart catheterization
3. Transseptal crossing (through defect in ASD/PFO)
4. Defect sizing (balloon)
5. Appropriate device selection
6. Device deployment
7. TEE/ICE control
8. Device release
9. Final angiography

Procedure Duration and Hospital Stay

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• Procedure time: 1-2 hours
• Hospital stay: 1 night
• Discharge: Next day

Treatment Outcomes

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ASD Closure

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PFO Closure

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VSD Closure

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Post-Procedure Care

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Medications

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First 6 months:

• Aspirin (100 mg/day)
• Clopidogrel (75 mg/day) - first 1-3 months

After 6 months:

• Aspirin monotherapy (6 months - 1 year)

Endocarditis Prophylaxis

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• First 6 months: Required
• After 6 months: Not required if complete closure

Follow-up Program

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Activity Restrictions

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• First week: No heavy activities
• First month: No contact sports
• After 1 month: Normal activity

Complications

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Intraprocedural

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Early Period

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• Access site hematoma: Compression
• Headache: Common, transient
• Chest pain: Mild, transient

Late Period

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• Device erosion: <0.1%
• Thrombus formation: Rare (with antiplatelet)
• Residual shunt: 5% (usually clinically insignificant)
• New arrhythmias: Rare

Special Situations

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Large ASD

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• Defect >38 mm: Prefer surgery
• Insufficient rim: Surgery
• Multiple defects: Catheter in experienced centers

Atrial Septal Aneurysm + PFO

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• Both can be closed together
• Higher stroke risk
• Good prognosis after closure

Diving and Flying

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PFO + Diving:

• Increased decompression sickness risk
• Closure should be considered for professional divers

PFO + Pilot/Flight Personnel:

• High altitude exposure
• Occupational assessment required

Catheter vs Surgery

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Frequently Asked Questions

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Appointment and Contact

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To schedule an appointment for heart hole evaluation and closure procedure:

📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul, Turkey

📞 Phone: +90 212 665 50 50 (Extension: 4012)

This content has been prepared by Assoc. Prof. Habib Çil for informational purposes only. Please consult a cardiology specialist for accurate diagnosis and treatment.

Related Structural Heart Interventions

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Other services related to heart hole closure:

• TAVI - Transcatheter aortic valve implantation
• MitraClip - Mitral valve repair
• Alcohol Septal Ablation - HOCM treatment
• Balloon Valvuloplasty - Valve opening procedure