Device Closure is used to close a defect or an opening between the right and left
sides of the heart. A heart has four chambers. The upper two chambers are called at
Atria. Atria are separated by a wall which is called Atrial Septum. The lower
chambers are known as Ventricles- Right and left. Pulmonary Veins supply Oxygenated
blood to the Left Atrium. This left atrium, in turn, sends this oxygenated blood to
the Left Ventricle through Mitral Valve, for circulation of oxygenated blood in the
The walls of the heart are well separated maintaining a good circulation system. But in some congenital heart defect situations, if there are any holes on the heart, either in the atrial wall or the ventricle wall, this can result in disturbed blood circulation resulting in performance failure of the heart. If the holes are particularly small, they can be filled up surgically, with some metal parts. This concept is known as DEVICE CLOSURE. So, in short, in Device Closure, there is a metal device that is surgically placed in the place where there is a whole in a heart, in order to maintain the heart’s performance.
This treatment involves using Closure Devices, which are implants, to treat patients with Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA)
Atrial Septal Defect (ASD)
This is a congenital heart defect in which blood flows between the atria (upper
chambers) of the heart.
A wall called the Interatrial Septum separates the Atria. If this septum is defective or absent, then oxygen-rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart, or vice versa. This causes lower-than-normal oxygen levels in the arterial blood that supplies the brain, organs, and tissues.
However, an ASD may not produce noticeable signs or symptoms, especially if the defect is small.
Ventricular Septal Defect (VSD)
This is a defect in the ventricular septum, the wall dividing the left and right
ventricles (lower chambers) of the heart. The extent of the opening may vary from
pin size to complete absence of the ventricular septum, creating one common
The ventricular septum consists of an inferior muscular and superior membranous portion and is extensively innervated with conducting cardiomyocytes (cardiac muscle cells).
The more common type of VSD is one where the membranous portion, which is close to the atrioventricular node, is affected.
Patent Ductus Arteriosus (PDA)
This is a condition wherein the ductus arteriosus (fetal blood vessel) fails to close
after birth. This vessel does not close and remains "patent" (open), resulting in
irregular transmission of blood between the aorta and the pulmonary artery.
PDA is common in newborns with persistent respiratory problems such as hypoxia and has a high occurrence in premature newborns due to underdevelopment of the heart and lungs.
Symptoms might not appear in the baby’s early days, but in its first year, there might be increased 'work of breathing' and poor weight gain. If left untreated, may lead to congestive heart failure with increasing age.
Common Part of the Procedure
The procedure for all the three: ASD, VSD and PDA are usually performed in the
cardiac catheterisation lab. It is called transcatheter device closure because
catheters (thin, flexible tubes) are part of the cardiac catheterization procedure.
Usually, the catheter will be inserted via a blood vessel in the groin and navigated until it reaches the heart using fluoroscopy.
The procedure differs slightly for all the three cases:
The catheter is positioned at different chambers of your heart to measure the pressure and oxygen content prior to device closure. Sometimes, balloon sizing of the ASD may be required. The appropriate size device is connected onto a cable, put into a special delivery tube, advanced through your ASD and carefully deployed.
The Amplatzer(commonly used) muscular VSD occluder may be used to close certain VSDs. It is shown to have full closure of the VDS within the 24 hours of placement. It has a low risk of embolism after implantation.
This procedure is usually done in infants or children who are large enough to have the procedure. Through the catheter, a plug or coil is inserted to close the ductus arteriosus.If no complications arise, and the child can be taken home next day