Percutaneous closure procedures

Closure procedures are used to treat heart defects.

 

What are heart defects?

Heart defects are structural problems caused by abnormal formation of the heart or major blood vessels. These abnormalities, when they occur, are usually present from birth but can take many years, even several decades to cause problems.

Atrial septal defect (ASD) is a condition where there is connection between the two top chambers in the heart (the atria). Ventricular septal defect (VSD) is a condition where there is connection between the two lower chambers in the heart (the ventricles). Figure 1 demonstrates where these defects occur in the heart (and their multiple sub-types). Eventually, these abnormalities can lead to symptoms of breathlessness or stroke and cause abnormal enlargement of the heart chambers leading to progressive heart failure.

A patent foramen ovale (PFO) is a different type of connection (patency) between the top chambers of the heart (the atria) that can exist normally in up to 25 per cent of the general population from birth and remain for life without complications. In some people, it can be a cause of stroke (in very specific situations) and where it is thought that a stroke has been caused by a PFO it may be appropriate for a device to be inserted to close the PFO. This is a careful assessment that requires input from both neurologists and cardiologists working in a multidisciplinary patient care team.
 
Figure 1:
heart

How can heart defects be treated?

The current treatment standard for many of these defects is via deployment of a repair device (made of titanium nickel alloy in most cases) by advancing a tube up through the leg into heart under x-ray and ultrasound guidance. However, some of these abnormalities are sometimes better treated by open heart surgical repair. Your treating team will guide you through the treatment that is most suitable for you and provide you the care option that you need.

Where a decision is made with you and your treating team to proceed with the minimally invasive percutaneous procedure (i.e. delivery of a repair device via the veins and / or arteries in the legs under x-ray and ultrasound) the procedure usually involves the following steps:

  • General anaesthetic (fully put to sleep) with a breathing machine to support breathing.
  • An ultrasound probe (transoesophageal echocardiogram probe) is placed down your food pipe to visualise the heart.
  • Tubes are also inserted in the vein and or artery in the leg as well depending on the nature of the abnormality being treated. These tubes are called sheaths.
  • A delivery cable carrying the repair device is taken up to the heart through the sheaths (tubes described in the point above) and positioned to repair the abnormality (examples of these devices are shown in Figure 2).

 
Figure 2:

closure devices

Are there any risks with percutaneous closure procedures?

These procedures have many potential risks. The information supplied here is for general reference only based on the published data around the procedures from across the world. Risks specific to your condition and overall situation need to be discussed with your treating doctors.

Potential risks of percutaneous closure procedures vary (and is highly patient and procedure dependant) but can include:

 

  • Failure of the procedure to successfully modify the heart enough to improve symptoms (and may require repeat procedures).
  • If the arm / wrist artery is used, 5 – 10% risk of that pulse blocking / disappearing permanently.
  • Bruising and pain, sometimes with a large bruise (called a haematoma) at the area where the tubes go in that can take several weeks to resolve.
  • Stroke or embolism (resulting in permanent disability, blindness, limb loss or death).
  • Vascular access complication (problem with the artery or vein leading to the heart) needing an operation or medication injection (thrombin) to fix and or requiring a blood transfusion and uncommonly resulting in permanent nerve damage or loss of limb (rare).
  • Post procedure infection, blood clot (DVT) and pain.
  • Device infection that requires antibiotics and possibly open-heart surgery to remove and repair.
  • Embolisation / dislodgement that can require open heart surgery to retrieve and manage.
  • Adverse reaction to the general anaesthetic leading to permanent disability or death (<1/10,000).
  • Failure of the procedure to successfully modify the heart enough to improve symptoms (and may require repeat procedures).
  • If the arm / wrist artery is used, 5 – 10% risk of that pulse blocking / disappearing permanently.
  • Bruising and pain, sometimes with a large bruise (called a haematoma) at the area where the tubes go in that can take several weeks to resolve.
  • Stroke or embolism (resulting in permanent disability, blindness, limb loss or death).
  • Vascular access complication (problem with the artery or vein leading to the heart) needing an operation or medication injection (thrombin) to fix and or requiring a blood transfusion and uncommonly resulting in permanent nerve damage or loss of limb (rare).
  • Post procedure infection, blood clot (DVT) and pain.
  • Device infection that requires antibiotics and possibly open-heart surgery to remove and repair.
  • Embolisation / dislodgement that can require open heart surgery to retrieve and manage.
  • Adverse reaction to the general anaesthetic leading to permanent disability or death (<1/10,000).
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    Level 4, Suite 22, Melbourne Private Medical Centre, Royal Parade, Parkville VIC 3052

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    Suite 3 Mount Medical Centre, Level 3, 140 Mounts Bay Road, Perth WA 6000

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    Pindara Specialist Suites Suite 4.07, Level 4, 29 Carrara Street, Benowa Qld 4214

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    Level 2, 50 New Street, Ringwood VIC 3134

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    Mater Hospital (Outpatients Department) 31 Ward Street Rockhampton QLD 4700

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    Rockhampton Hospital, Lower Ground Floor, Canning Street, Rockhampton, QLD, 4700

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    Vital Health, 20 Quintin Street, Roma QLD 4455

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