An atrial septal defect — a hole in the wall between the two upper chambers of the heart — once required open-heart surgery to repair. Today, in suitable patients, it can be closed with a small device delivered through a catheter in the leg, with no chest incision and a recovery measured in days rather than weeks.
The atrial septum is the wall separating the left and right atria. An atrial septal defect (ASD) is a congenital opening in this wall that allows blood to flow abnormally between the two chambers. Small defects may cause no symptoms and require no treatment. But larger defects can, over time, overload the right side of the heart and the lungs, leading to symptoms and complications if left untreated.
Why Close an ASD?
A significant ASD allows oxygen-rich blood to shunt from the left atrium back into the right atrium, forcing the right heart and the pulmonary circulation to handle more blood than they should. Over years, this can cause right heart enlargement, pulmonary hypertension, atrial arrhythmias such as atrial fibrillation, and reduced exercise capacity. Closing a significant defect prevents these complications and, in many patients, reverses right heart enlargement.
How Percutaneous Closure Works
The procedure is performed in the catheterisation laboratory, usually under sedation or light general anaesthesia, and guided by echocardiography (often transoesophageal or intracardiac echo) alongside X-ray. A catheter is introduced through the femoral vein in the groin and advanced to the heart. A closure device — a self-expanding double-disc made of a nitinol mesh — is passed through the catheter, positioned across the defect, and deployed so that one disc sits on each side of the septum, sandwiching the hole closed.
Over the following weeks and months, the body's own tissue grows over the device, incorporating it permanently into the septal wall. The whole procedure typically takes around an hour, and most patients go home the next day.
"For the right patient, closing an ASD through a catheter offers the same result as surgery — without the chest incision, the bypass machine, or the long recovery."
— Dr. Zaidoun Hajali, MD FSCAI FRCPWho Is a Candidate?
Not every ASD is suitable for device closure. The ideal candidate has a secundum-type ASD (the most common type, located in the central part of the septum) with adequate rims of tissue around the defect to anchor the device securely. Other types of ASD — such as primum, sinus venosus, or coronary sinus defects — usually require surgical repair because of their location. Echocardiography, and sometimes additional imaging, determines suitability before the procedure.
Recovery and Afterwards
Recovery from percutaneous ASD closure is remarkably quick compared with surgery. Most patients are discharged within 24 hours and return to normal activities within a few days, avoiding strenuous activity for a short period. Antiplatelet medication (usually aspirin, sometimes with clopidogrel) is prescribed for several months while the device endothelialises. Follow-up echocardiography confirms correct device position and complete closure.
- An atrial septal defect (ASD) is a hole in the wall between the heart's upper chambers; significant defects overload the right heart over time.
- Percutaneous closure uses a self-expanding double-disc device delivered through a vein in the groin — no chest incision.
- The procedure takes about an hour, is guided by echocardiography, and most patients go home the next day.
- Ideal candidates have a secundum-type ASD with adequate tissue rims; other types usually need surgery.
- Recovery is far faster than surgery, with antiplatelet medication for several months while the device heals in.
