An atrial septal defect is a birth defect and consists of an opening in the wall that separates the left atrium from the right atrium. As a result of this pure blood comes into the right atrium from the left atrium and mixes with the impure blood. Thus the right atrium receives more blood than it is supposed to and pushes it into the right ventricle and from there in to the lungs. Due to this increased blood flow in the lungs these patients especially during childhood are prone for recurrent lung infections and they can have a progressive increase in the blood pressure in the lungs. Hence if this defect is causing a significant increase in the blood supply to the lungs (more than twice the blood supply to the body) it needs to be closed. ASD's may be classified into ostium primum, ostium secundum or sinus venosus.
Traditionally surgery was needed to close all defects, but today a large percentage of ostium secundum can be closed without surgery. The device consists of two discs which are connected together by and waist which fits the size of the defect in the septum and this device is made of nitinol. A catheter ( a thin long tube) is passed along a large vein from the groin and advanced into the heart and guided from the right atrium into the left atrium through the atrial septal defect. The device is then stretched and taken through the catheter and the left atrial disc is released in the left atrium and the the catheter is pulled back into the right atrium and the right atrial disc is released in ti the right atrium. So now we have 2 discs, one in the left atrium and another in the right atrium. These two discs are connected by the waist which exactly fits the defect and closes it. This procedure is done under x-ray and ultrasound guidance. The patients are generally discharged on day two and need to take aspirin for a period of 6 months.
A ventricular septal defect is a birth defect where there is an abnormal defect in the interventricular septum resulting in an abnormal communication between the right and left ventricle. This results in passage of pure blood from the LV to the RV and increased blood flow into the lungs. People with small defects are generally asymptomatic and require no treatment and those with moderate to large defect present with recurrent lung infections. Those with large defects may present with failure to thrive and heart failure. Depending on the location of the defect on the septum they could be called muscular, perimembranous and inlet variety. Surgery is the treatment of choice but lately percutaneous closure has become the treatment of choice in many muscular vsd's and an acceptable alternative n selected perimembranous vsd's.
The device consists of two discs which are connected together by and waist which fits the size of the defect in the septum and this device is made of nitinol. A catheter ( a thin long tube) is passed along a large vein from the groin and advanced into the heart and guided from the right ventricle into the left ventricle through the ventricular septal defect. The device is then stretched and taken through the catheter and the left ventricular disc is released in the left ventricle and the the catheter is pulled back into the right ventricle and the right ventricular disc is released in ti the right ventricle. So now we have 2 discs, one in the left ventricle and another in the right ventricle. These two discs are connected by the waist which exactly fits the defect and closes it. Once the position is confirmed the device is released from the delivery cable. This procedure is done under x-ray and ultrasound guidance. The patients are generally discharged on day two and need to take aspirin for a period of 6 months.
Patent ductus arteriosus (PDA) represents the persistence of a communication between the aorta and pulmonary artery which is very essential for the fetus and normally shuts down in the majority within 24 hours of birth. This results in passage of pure blood from the aorta into the lungs and again depending on the size of the defect could be asymptomatic, present with recurrent lung infections and heart failure. Percutaneous closure is the treatment of choice unless it is accompanied by other birth defects which require surgery. Percutaneous closure is done with coils or devices. In small PDA's coil may suffice larger defects are preferably closed with devices. Through a catheter a device or a coil is positioned in the PDA resulting in closure of the duct.
