Atrial septal defect;
Atrial Septal Defect (ASD) is a defect in any part of the wall separating the right and left atria in the heart, allowing flow that should not normally occur between the left and right atrium. . In the presence of ASD, clean blood from the left atrium passes to the right atrium and the amount of blood that the right heart must pump and reaches the lungs increases. ASD is seen in 10-15% of congenital heart diseases and is the most common congenital heart disease in adults. It is approximately twice as common in women as in men. In addition, ASD formation may be observed later following specific procedures performed in the field of cardiology. Although this situation is innocent, in some cases the hole may need to be closed. The disease usually progresses without symptoms. In some patients, it may manifest itself as inability to gain weight during childhood, bruising, or the diagnosis may be made due to a heart murmur heard during a general examination. The definitive diagnosis of patients is made by heart ultrasonography (echocardiography). After a detailed evaluation in diagnosed patients, intermittent control, open heart surgery or insertion of an umbrella through the groin vein may be selected as treatment options. The diagnostic delay that may be observed in these patients may cause serious clinical problems by causing changes in the normal pressure values in the heart chambers. Symptoms in patients may manifest themselves with shortness of breath, fatigue, weakness and palpitations, mostly in older ages. In advanced cases, enlargement of the heart chambers, increased lung pressure and death due to heart failure may occur. In addition, clots produced in the venous system can pass through this hole and go to the brain, causing strokes.
In patients diagnosed at any time in life, it may be decided to close the hole after pressure measurement with echocardiography, transesophageal echocardiography (echocardiography through the esophagus, TEE) and angiographic methods. If the amount passing from the left atrium to the right atrium via ASD is above a certain amount, ASD should be turned off. In this case, a patch is placed between the atria in the form of open heart surgery or, in appropriate cases, inguinal balls are removed. It may be possible to close the hole by entering the vein and placing special devices called umbrellas (non-surgical method).
The procedure is performed in the coronary angiography (or catheter) laboratory. This is performed by a team consisting of specially trained interventional cardiologists, nurses and 3 technicians. This process takes approximately 30-45 minutes in suitable cases. Since TEE is usually required during the procedure, the procedure is performed under general anesthesia. Through a small incision in the groin, the inguinal vein is entered with the help of special needles. It is then advanced to the heart with the help of special tubes and wires. Necessary checks are made by moving from the right atrium of the heart to the left atrium. ASD closure devices are in the form of two disks connected to each other. The closure device selected in accordance with the hole diameter is advanced through the pipe and the hole is passed. One disc of the device is opened in the left atrium, the second disc is opened in the right atrium, the hole is closed, and the process is completed by taking the tube back. Compression is applied to the vein in the groin and a sandbag is placed. The closing device remains in the wall at all times. The patient does not feel the presence of the device. The patient's hospital stay is much shorter than surgery (6-24 hours). Unlike the surgical method, there is no need to open the chest and connect to a heart-lung machine.
Undesirable situations may occur at a rate of 1-9% during and after the procedure. During the procedure, there may be rupture, puncture and related bleeding in the vein where the intervention is applied. When bleeding occurs, bruising may occur in the groin area, which can last up to 1 month. Rarely, infections that require intravenous or oral antibiotics may occur. When an opaque substance must be used during the procedure, allergic conditions may develop against this substance. During the placement of the device in the heart, sudden fluid accumulation around the heart may occur and require urgent intervention (0.2%). Life-threatening brain emboli may develop before device placement, causing mostly temporary but rarely permanent paralysis (1%). Within 3-6 months after the device is placed, clots may form around the device and cause strokes (0.6%). The implanted device can be separated from its place and enter the cavities of the heart or the main vein. If it falls to 0.1%, emergency open heart surgery may be required (0.1%). In rare cases, ruptures in the heart structures may be observed during the procedure. Although very rare (0.03%), death may occur during the procedure. Continuation of small shunts (blood passing from left to right) despite the device being placed is also among the complications.
Heart failure and arrhythmia may occur if the Atrial Septal Defect, which is decided to be closed in the heart cavities, is not closed. You should be aware that you will be accepting any risk of paralysis or death resulting from this situation. In addition, it should not be forgotten that when the heart enlarges, lung blood pressure increases and the transition from right to left begins due to the blood flow in ASD, the chance of closure will disappear. If you decide to have this procedure done later, you can contact our clinic, make an appointment and have the procedure done on the given date. Are there alternative examination methods that can replace percutaneous Atrial Septal Defect closure? According to current medical knowledge, there is no known effective treatment for atrial septal defect, which causes serious health problems, other than open heart surgery (patch or repair) and insertion of an umbrella through the inguinal vein. The other method, open heart surgery, may also have its own complications. What are the lifestyle changes that need to be made after the procedure? The patient can be discharged the day after the procedure and can return to normal life and work within a few days.
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