Until recently, children with atrial septal defects would often require open heart surgery to repair a hole in their heart. Now, pediatric cardiologists at the University of Maryland Hospital for Children are avoiding surgery by using a new mesh device, delivered through a catheter, to treat this common congenital heart defect.
"This type of treatment is much less traumatic for children because they are able to go home a day after the procedure, and there is no incision or scarring to remind them that their heart was fixed," says Jon C. Love, M.D., assistant professor of pediatrics at the University of Maryland School of Medicine and pediatric cardiologist at the University of Maryland Hospital for Children.
An atrial septal defect, or ASD, is an abnormal hole in the wall of the upper chambers of the heart. The size of the hole and its exact location vary from patient to patient. An ASD can increase the amount of blood that flows to the lungs. During childhood, there may be no symptoms, but over time the condition can lead to pulmonary hypertension or congestive heart failure.
An ASD can close on its own but more often than not needs repairing. It is typically repaired in children between three and five years of age, but infants and older children may also undergo the treatment when necessary. In the past, these young patients would require open heart surgery that would include stopping the heart and using a heart/lung machine.
The most common ASD is the secundum-type, where the hole is located in the central part of the atrial septum. By using the mesh device called the Amplatzer, pediatric cardiologists are now able to close the hole in a hospital procedure room known as the catheterization laboratory. The patient receives general anesthesia, and no large incision is needed. The recovery time is just a few days.
The Amplatzer, which was FDA approved earlier this year, is a two-tiered, expanding device that closes the ASD. There are different sized devices, ranging from 4 millimeters to 3.8 centimeters. The cardiologist determines what size Amplatzer to use by inflating a balloon within the defect, and measuring the indentation in the balloon, created by the defect. The Amplatzer, which is made of wire mesh, is then inserted through that same catheter and placed securely in the hole.
"The defect can be too large for the device," says Dr. Love. "There are limitations. There may not be enough tissue to hold it in place or it may sit in an area that compromises a valve." But overall, the Amplatzer has been a very successful option in treating a pediatric patient with an ASD.
A ventricular septal defect, or VSD, is a hole in the wall between the two lower chambers of the heart. While closing an ASD in the catheterization laboratory is a new procedure, similar devices have been used in experimental protocols to close VSD's.
"We've come a long way. It was in the 1970's when cardiologists began taking children into the operating room to repair complex heart problems. With the 80's, the cardiac catheterization laboratory began to be used more often as a place to repair defects, as opposed to just diagnose a problem. In the 90's, surgeons improved techniques to fix cardiac problems in infants and newborns. Now, we have a new device that is part of a continuing trend to treat and prevent congestive heart failure in children without surgery," says Dr. Love.
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