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DEVICE CLOSURE

Different types of closure devices are used to close a hole or an opening between the right and left sides of the heart. Some of these birth defects are located in the wall (septum) between the upper chambers (atria) of the heart:

  •  Patent Foramen Ovale (PFO)
  •  Atrial Septal Defect (ASD)

Definition: :

The percutaneous closure of PFO and ASD is performed using a special closure device. The device is folded or attached on to a special catheter, similar to the catheter used during your catheterization. The special catheter is inserted into a vein in the leg and advanced into the heart and through the hole. The device is slowly pushed out of the special catheter allowing each side of the device to open up and cover each side of the hole (like a sandwich), closing the hole or defect. When the device is in proper position, it is released from the special catheter. Over time, heart tissue grows over the implant, becoming part of the heart. The PFO AND ASD closure procedure is monitored by X-ray and an ultrasound camera inserted in the heart from a vein in the groin.

To prepare:

  •  You can wear whatever you like to the hospital. You will wear a hospital gown during the procedure.
  •  Leave all valuables at home. If you normally wear dentures, glasses or a hearing assist device, plan to wear them during the procedure.
  •  Your doctor or nurse will give you specific instructions about what you can and cannot eat or drink before the procedure.
  •  Ask your doctor what medications should be taken on the day of your test. You may be told to stop certain medications, such as Coumadin (warfarin, a blood thinner).
  •  If you are diabetic, ask your physician how to adjust your medications the day of your test.
  •  Tell your doctor and/or nurses if you are allergic to anything, especially iodine, shellfish, x-ray dye, latex or rubber products (such as rubber gloves or balloons).
  •  You may or may not return home the day of your procedure. Bring items with you (such as robe, slippers and toothbrush) that may make your stay more comfortable. When you are able to return home, arrange for a companion to bring you home.

What to expect:

  •  You will be given a hospital gown to wear.
  •  A nurse will start an intravenous (IV) line in your arm so that medications and fluids can be administered during the procedure.
  •  The cardiac catheterization (cath) room is cool and dimly lit. You will lie on a special table. If you look above, you will see a large camera and several TV monitors. You can watch your cardiac cath on the monitors.
  •  The nurse will clean your skin at the site where the catheter (narrow plastic tube) will be inserted (arm or groin). Sterile drapes are used to cover the site and help prevent infection. It is important that you keep your arms and hands down at your sides and not disturb the drapes.
  •  Electrodes (small, flat, sticky patches) will be placed on your chest. The electrodes are attached to an electrocardiograph monitor (ECG), which charts your heart’s electrical activity.
  •  You will be given a sedative to relax you, but you will be awake and conscious during the entire procedure.
  •   The doctor will use a local anesthetic to numb the site. A plastic introducer sheath (a short, hollow tube through which the catheter is placed) is inserted a blood vessel in your arm or groin. A catheter will be inserted through the sheath and threaded to the arteries of your heart.

After the procedure:

  •  The catheters and sheath are removed from your groin. Pressure will be placed on the leg artery. You will need to lie flat and keep the leg straight for three to six hours to prevent bleeding. A pressure dressing will be applied tightly on the groin. The nurse will check your bandage regularly, but call your nurse if you think you are bleeding (have a wet, warm sensation) or if your toes begin to tingle or feel numb. You will need to be on bedrest for several hours.
  •  You may have some tenderness in your groin at the site of insertion. Your throat may feel slightly sore if an transesophageal echocardiogram was performed.
  •  You will need to drink plenty of liquids to clear the contrast material from your body. You may feel the need to urinate more frequently. This is normal.
  •  You will need to stay in the hospital overnight. The nurses will monitor your heart rate and rhythm. Before you leave the hospital, you will have an EKG, blood tests and a chest x-ray and/or echocardiogram to ensure the device is positioned properly.
  •  Before you leave the hospital, your doctor and nurse will discuss your medications and when you can return to normal activities. You will be prescribed a medication to prevent blood clots from forming, such as Aspirin for at least six months after the procedure. Your doctor will discuss follow-up and how long he would like you to continue your medications.
  •  Most children and adults with congenital heart disease should be monitored by a heart specialist and take precautions to prevent endocarditis throughout their life. Check with your doctor if you need to be protected from endocarditis life-long or may discontinue precautions 6 months after your procedure.

Smoking is a major risk for several diseases including heart disease, stroke, and several cancers. Even low-tar cigarettes and light smoking can increase the risk of heart disease substantially. There are now several alternative approaches to helping people stop smoking. These include nicotine-replacement patches and gum as well as oral medication.

If you are able to stop smoking, your risk of a heart attack or stroke decreases within a few weeks. The risk goes down to that of a nonsmoker within about 2 years. In addition, a lot of patients comment that they feel healthier and have more energy after they've stopped smoking.

Hypothyroidism can increase blood cholesterol levels and that contributes to heart disease; however, if the hypothyroidism is being treated with a thyroid hormone, then the cholesterol returns to normal.

Birth control pills can cause a small increase in the risk of thrombosis and heart attack. That occurs mainly in people who have been on the pill for more than 10 years and who smoke cigarettes.

There is an increase in the risk of heart attack if a first-degree relative (parent or sibling) has had a heart attack or stroke. That is mainly seen when the relative has had a heart attack before the age of 45 if they are male, 55 if they are female. Obviously, you cannot change your family history, but a positive history should suggest the need to improve all the other risk factors like stopping smoking and decreasing cholesterol.

Heart disease is potentially reversible by attending to risk factors like cholesterol, blood pressure, and smoking. Several studies have shown, for example, that aggressive lowering of blood cholesterol with LDL levels below 100 can open up blocked coronary arteries at least partially. Perhaps I should explain that LDL cholesterol is the "bad" cholesterol component.

I would suggest a diet that is balanced among all the main food groups, with fat content making up no more than 30 percent of calories and most of that fat being unsaturated. I would not advise patients to eat a diet that is restricted in carbohydrates or fruits and vegetables, because this may adversely affect vitamin intake and blood cholesterol.