Closing your Atrial Septal Defect without SurgeryClosing your Atrial Septal Defect without Surgery Read this booklet to learn: • what an atrial septal defect is • why it is important

Closing your Atrial Septal Defect without Surgery

Read this booklet to learn:

• what an atrial septal defect is

• why it is important to close this hole

• what to expect with this procedure

• who to contact if you have any questions

What is an Atrial Septal Defect?An atrial septal defect is a hole in the wall that divides the two upper chambers (atria) of your heart. People are born with these defects. The holes can range from the size of a penny to a little larger than a toonie.

Information for patients and families

Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca© 2017 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only.

Author: Sue Jimeno RN, BScN, Nurse CoordinatorRevised: 04/2017Form: D-5245

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Why is it important to close this hole?This hole may eventually damage your heart and lungs. The extra flow through the hole may cause:

• the right side of your heart to become bigger

• the tricuspid valve (a valve on the right side of your heart) to leak

• your heart rhythm to become abnormal

How can this hole be closed without surgery?We use a device that has 2 discs called an ASD septal occluder. It has a stem in the middle that is sized to your defect. This device is made of an elastic-like metal and polyester fabric.

ASD septal occluder

We may also use something called a Gore® Septal Occluder, which is another type of occluder.

Gore® Septal Occluder being used to close an ASD

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First, a tube is put into a vein in your leg. Next, a balloon is used to size the hole. Then the occluder is moved through the tube and up the vein to your heart. The occluder is placed in the hole to close it.

How do I know if this is right for me?We go through these steps to decide if this procedure is right for you:

1. You have a transesophageal echo (TEE) before you meet the doctor. The test shows if the hole can be closed with this procedure.

2. Depending on the results of the TEE, you may also have an MRI of your heart. An MRI allows your doctor to see images (pictures) of your heart.

3. You meet with Dr. Eric Horlick or Dr. Mark Osten to:

• talk about the procedure

• ask any questions you may have

• talk about the risks and benefits of the procedure and other options

What can I expect?If you decide to go ahead, we will make an appointment for the procedure. Here are the steps you will go through:

1. Appointment at the Pre-Admission Clinic:

You meet with one of our nurses and have some blood tests. The nurse will give you a list of instructions to follow before your procedure. Please bring all of the medicines you are taking with you to your appointment.

2. On the day of your procedure:

Come to the Eaton Building – 2nd Floor, Cath Lab, CICU, CVICU Waiting Area at the Toronto General Hospital.

You will have the procedure later that morning or afternoon. You will see Dr. Horlick, Dr. Osten or Dr. Benson at that time. You will stay overnight at the Cardiac Short Stay Unit 5A.

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There is a chance that your procedure may be cancelled if a more urgent situation comes up. If this happens, your procedure will be rescheduled as soon as possible.

3. For the procedure:

The procedure takes about 30 to 45 minutes. Here is what you can expect:

a. You receive a local anaesthetic in the groin area, using a needle. This numbs the area where we insert the tube.

b. You receive a sedative and painkiller by intravenous (IV). These medicines help you stay relaxed and comfortable during the procedure.

c. A small catheter (tube) is placed in your vein at the groin site. It is moved through the right atrium of your heart, then through the defect (hole) to reach the left atrium. We measure the size of the hole using a special balloon. Then we can choose the size of the occluder needed to fit perfectly.

d. We attach and fold the occluder so that it fits inside the tube. Then we pass the occluder through the tube until it goes through the hole in your heart. First we open the disc on the left side of the opening, and then we open the disc on the right side. This covers the hole completely, like a patch. The 2 discs are joined by a stem that passes through the hole.

e. The tube is removed and we observe you in the holding area for 20 minutes. Then we return you to your room.

When can I go home?

The morning after your procedure, you will have an echocardiogram (an ultrasound of your heart). An echocardiogram will help your doctor make sure the occluder is in the right position and there is no fluid around your heart.

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What can I do when I go home?

• You can do normal activities as soon as you get home (such as walking around the house, making meals).

• Wait 2 weeks before you start any exercises like running or weight lifting.

• Avoid contact sports (like hockey or football) for 1 month.

Are there any side effects?You may have minor pain or bruising in the groin for a few days. Most patients have no other side effects from the procedure. Some may have:

• palpitations or skipped heart beats that can last a few days up to 6 to 8 weeks

• migraine headaches that are new or worse than before (if you had migraines before). These can last up to 6 to 8 weeks.

• minor chest discomfort that comes and goes for about a week

Call your doctor's office or go to the nearest emergency room if:

• you have heart palpitations (your heart beats very quickly or skips beats) continuously for 10 minutes or longer

• you have very bad chest pain

• you are very light-headed and feel like you are going to faint

Please call your doctor’s office about any concerns you may have.

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What medicine will I take after the procedure?

You will take one Aspirin® 81 milligram tablet every day for 6 months. You will also continue with Coumadin® if you have already been taking it.

During the first 6 months after your procedure, you need to take antibiotics if you are having:

• any dental work

• any surgery involving your bladder, stomach or lung

You will need to take an antibiotic at least 1 hour before your appointment. Your dentist or family doctor can give you the prescription. Please tell your doctor before you have any of these procedures.

What follow-up will I get?

You will see Dr. Horlick or Dr. Osten 8 to 12 weeks after your procedure. Your appointment will be on the 5th floor, Ambulatory Cardiac Clinic. This is in the New Clinical Services Building, Toronto General Hospital.

Then your own cardiologist will follow your progress. You will get tests from time to time, such as electrocardiograms (measures the electrical activity in your heart) and surface echocardiograms. This will be part of your follow-up.

If you need more information about your follow-up, please contact the Ambulatory Cardiac Clinic at:Phone: 416 340 5309Toll-free: 1 888 UHN HARTFax: 416 340 4127Email: [email protected]

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What results can I expect?We can see the results of your procedure right away. We have had excellent results with these occluders for over 15 years. For many patients, the hole is sealed completely.

A small number have had very minor leaks around the occluder, but these leaks have very little effect.The goal of this procedure is to return the size of the right side of your heart to as close to normal as possible.

Who can I contact for more information?The people listed beloe can give you more information. They are all located at:

Toronto General Hospital200 Elizabeth StreetToronto ON, M5G 2C4

Dr. Eric HorlickRoom 6E 249Phone: 416 340 3835Fax: 416 340 3000

Dr. Mark Osten Room 6E 238Phone: 416 340 4615Fax: 416 340 4144

Sue JimenoClinical Coordinator, Structural Heart Disease Program Room 6E 223Phone: 416 340 4800, extension 6258Fax: 416 340 5143

University of Toronto Congenital Cardiac Centre for Adults

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