Those days it was a major operation – open heart surgery lasting about three hours to close those holes that some are born with, followed by many days in the Intensive Care Unit (ICU) and a long scar on the chest forever.
Now, it is just a 5-10-minute procedure, with the only cut, a tiny 1 mm, being far from the heart, on the groin, through which a catheter is inserted along with a ‘closure device’ through a vein, MediScene understands.
 |
| Dr. Gamini Galappatthy |
This procedure has been carried out at the Institute of Cardiology, National Hospital since 2006 on about 1,450 patients with Atrial Septal Defects (ASD)s, explains Consultant Cardiologist Dr. Gamini Galappatthy, pointing out the drastic difference between this technique and open heart surgery. (See box for ASDs)
“Open heart surgery entails the patient being put on the heart-lung machine, the heart stopped and opened up, the hole sewn with a patch taken from the outer layer of the heart (pericardium)," he says. After undergoing open-heart surgery, a patient has to be in the ICU for 3-5 days while after the other procedure done in the catheter laboratory under echo-scan guidance, the patient can go home the next day. “This will release the precious ICU beds for those more in need.”
Explaining that ASDs are common in females, with open heart surgery scars creating a problem when considering the cosmetic aspect, Dr. Galappatthy says they are diagnosed easily at a young age when a murmur is detected after which the patient is sent for an echo scan.
An ASD could be anything between 6 - 40 mm.
Eighty-five percent of ASDs can be treated through this ‘closure device’ which is like a twin umbrella, according to this Consultant Cardiologist.
Under this procedure, a catheter (a long, thin, flexible hollow tube) is inserted into a large vein through the incision in the groin and sent into the heart, says Dr. Galappatthy, adding that the closure device is then moved through this catheter to the location of the hole.
Once at the spot, the device with its two attached circular discs is allowed to expand its shape to straddle each side of the hole, sealing the hole and stopping the abnormal flow.
These discs are made of polyester fabric encased by a wire mesh of nitinol (a nickel-titanium alloy) which has a special shape memory, MediScene understands. “An internal cell layer covers it and after six months when we do an echo we can’t even find the difference,” says Dr. Galappatthy, adding that there are few side effects like the device jumping out of place if the hole size is measured wrong. “That happened those days in about 1% of the cases and a snare had to be sent in to catch it. However, now with echo-scans sizing is accurate.”
Another side-effect could be the formation of blood clots but we prevent that by prescribing a low dose of aspirin for about six months, he adds.
The cost of this procedure which could be between Rs. 175,000 and 300,000 is provided by the President’s Fund, it is learnt.
What is an Atrial Septal Defect (ASD)?
An ASD is a hole in the atria or chamber of the heart which is congenital or present at birth. It is an opening in the atrial septum or dividing wall between the two upper chambers of the heart known as the right and left atria, says Dr. Galappatthy.
This may occur when the foetus is in the mother’s womb around the first eight weeks of pregnancy, where the heart development is affected, resulting in an ASD. Usually, oxygen-poor (blue) blood returns to the right atrium from the body, travels to the right ventricle and is pumped into the lungs where it receives oxygen. Oxygen-rich (red) blood returns to the left atrium from the lungs, passes into the left ventricle, and then is pumped out to the body through the aorta, he says.
However, an ASD allows oxygen-rich (red) blood coming from the lungs to pass from the left atrium, through the opening in the septum to mix with the oxygen-poor (blue) blood in the right atrium and get sent to the lungs again. This over-works the lungs leading to development of pressure in lung vessels over a period of time, if the heart hole is not closed early.
An opening in the middle of the atrial septum (ostium secundum) is the most common type of ASD, MediScene learns, while girls have ASDs twice as often as boys. |
E-mail