Commonly Asked Questions About Children and Heart Disease

Updated:Nov 11,2014

Answers from the Pediatric Cardiologist

Question:
My 4-year-old daughter was recently diagnosed with a hole in her heart. It is called an atrial septal defect. We were told that it should be closed. I heard that there is a new way to close the hole without having surgery. Can this be done any way other than with surgery? My older son had a patent ductus arteriosus surgically repaired 10 years ago when he was 1 year old. Could his patent ductus arteriosus have been closed by this new method that does not require surgery?

Answer:
An atrial septal defect is a hole in the wall that separates the two upper chambers of the heart known as the right atrium and left atrium. The hole can be located in various locations in the wall (the septum). There are new methods of closing this hole without open-heart surgery, but it depends on the location of the hole. Presently, the only holes that can be closed are known as secundum atrial septal defect and patent foramen ovale (PFO). Both of these types of holes have an adequate rim around the hole onto which the device is attached. The non-surgical method of closure is by implanting a device, which resembles a dumbbell into the hole to "plug it up" from within the heart. This is accomplished by passing a small tube (catheter) from a vein located in the groin and up into the heart. The procedure is performed in the cardiac catheterization laboratory and does not require surgery. Several devices are available and the results have been comparable to surgical results. The risks, which are rare, are much the same as for any cardiac catheterization. They include clot formation, bleeding, infection, perforation of the heart, and arrhythmias (heart rhythm disturbances). For device implantation, device embolization is an additional risk (the device could break free and travel to another part of the heart or blood vessels), which may require surgical retrieval. This is an extremely rare risk because most of the devices are designed for safe repositioning and retrieval in the cath lab if necessary. Should embolization occur, the surgeon would simply repair the defect at the time of the retrieval. Another risk is a residual leak across the device, but usually the leak is sealed in two to six months as the body grows new tissue over the device. The cath procedure would also require transesophageal echocardiography, which is an echocardiogram performed with the probe passed down the throat to measure the size of the defect and assist in determining proper position of the device. The entire procedure is performed under general anesthesia. Keep in mind that you will need to be on aspirin for six months after the procedure. The aspirin is used to keep blood clots from forming on the device while the body heals over it. The risks of surgical closure would include most of the cath lab risks such as bleeding, infection, blood clots, arrhythmia and residual leaks. Other inherent risks involving open-chest and open-heart surgery include the need for blood transfusions, prolonged bed rest, lung collapse and lung infections, and fluid forming within the sac of the heart. Overall, both procedures are effective and have low risk. While surgery will be more painful and require longer recovery time and will result in a scar on the chest, it has a proven track record over many decades. The cath lab method is newer and the long-term results are not yet known but appear to be as good as surgery.
 

The patent ductus arteriosus can also be closed without surgery. It is similar to the ASD closure but different devices are available. The most commonly used device is called a coil, which has FDA approval for use in various unwanted blood vessels in the body. The coil has been in use for nearly 30 years and has proven to be quite safe and effective for the smaller PDA's. Other devices are available for larger PDA's, some of which are still investigational. Except for the very small infant, or the patient with a very large ductus, the preferred method of PDA closure in most pediatric cardiology centers is by cardiac catheterization.