Download Heart Defect Closure Without Surgery

Contact information
What You Can Expect After Discharge
You are able to resume your normal activities after discharge but avoid
strenuous exertion for 5 - 7 days to allow your leg puncture site to heal
fully. You may experience minor discomfort or bruising in the groin for a
few days. Avoid any form of contact or competition sports for a few months
to allow the device to stabilise.
Most patients have no symptom related to the septal occluder. Some may
have a sensation of skipped heart beats, aggravation of migraine headaches
or brief minor chest discomfort. Most of these symptoms will resolve within
a month of the procedure.
Patient with ASD or PFO will be discharged with a blood thinner (e.g.
aspirin or clopidegrel) which they have to consume for 6 months. You will
need to take antibiotics prior to dental work or certain surgeries for the
first 6 months after the procedure to prevent bacterial infection of the
heart. Any other medication will be at the discretion of our own doctor.
Heart Clinic @ Level 1
Main Building 1, Level 1
Opening Hours: 8.30 am - 6.00 pm (Mondays - Fridays)
Closed on Saturdays, Sundays & Public Holidays
For appointments, please contact
Tel: (65) 6772 2002
Email: [email protected]
For International Patients And Visitors
The International Patients Liaison Centre (IPLC) is a one-stop service centre to support
all the medical needs of our foreign patients
Tel
Fax
Website
: (65) 6779 2777 (24-Hours Helpline)
: (65) 6777 8065
: www.nuh.com.sg/iplc.html
National University Hospital
5 Lower Kent Ridge Road, Singapore 119074
Tel: 6779 5555 Fax: 6779 5678 Website: www.nuh.com.sg
Location
Results Of The Procedure
The results will be reviewed in detail when you meet your specialist. A small
number of patients have minor leaks around the occluder but these often
seal after a few months.
What Are The Possible Complications of
Device Closure?
•
•
•
•
Less than 1% chance of the device embolisation during the procedure.
Less than 1% chance of bleeding complications.
Migraine headache flare-ups, which usually subside after a month.
Abnormal heart rhythms (too slow or too fast).
What Are The Benefits Of Device Closure?
The primary benefit of having a device is that open heart surgery is avoided.
This results in:
• Shorter hospital stay and recovery time
• No chest scar
• Less pain
Talk to Us
If you will like to find out more, please contact:
Ms Margaret Choong
Ms Li Geying
DID: 6772-4081
DID: 6772-5456
Email: [email protected] Email: [email protected]
Free Shuttle Bus Service
Free Shuttle Bus Service from Dover MRT Station to NUH
Operation hours
: 8.00 am – 8.30 pm (Mondays – Fridays)
8.00 am – 2.00 pm (Saturdays)
Not available on Sundays and Public Holidays
Dover/NUH
: 1. Dover MRT Station (opposite Singapore Polytechnic)
passenger pickup/ 2. Main Building, Lobby Entrance (near roundabout)
drop off point
3. Kent Ridge Wing, Level 3, South Entrance
For more information on Shuttle Bus schedule, log on to www.nuh.com.sg
Information in this brochure is given as a guide only and does not replace medical advice from your
doctor. Please seek the advice of your doctor if you have any questions related to the surgery, your health
or medical condition.
Information is correct at time of printing (June 2011) and subject to revision without notice.
Heart Defect Closure
Without Surgery
Adult Congenital and Structural Heart
Disease Programme
Closing Your Congenital And Structural
Heart Defects Without Surgery
With advancement in the treatment of patients with congenital heart defects,
new methods of treating defects such as Atrial Septal Defects (ASD), Patent
Foramen Ovale (PFO) and Patent Ductus Arteriosus (PDA) have emerged.
These defects can now be closed without the need for an open heart surgery.
What Is An Atrial Septal Defects (ASD)?
An ASD is a hole in the dividing wall between the two upper chambers
(atria) of the heart. These defects are present from birth and can vary in
size, ranging from a five-cent coin to a fifty-cent coin. They may cause
damage to the heart and lungs if not treated.
Before birth, the two major arteries—the aorta and the pulmonary artery—
are normally connected by a blood vessel called the ductus arteriosus. After
birth, the vessel normally closes within a few days as part of the normal
changes occurring in the baby's circulation. In some babies, however, the
ductus arteriorsus remains open. This is called a PDA.
What Is A Patent Ductus Arteriosus (PDA)?
Aorta
Patent Ductus
Arteriosus
Left Ventricie
Right Ventricie
Figure 1: A Patent Ductus Arteriosus (PDA) allows blood to pass back to the
pulmonary artery, short circuiting oxygenated blood to the body and returning
some of it to the lungs.
Pulmonary Artery
Left Atrium
Atrial Septal Defect
What Are Percutaneous Occluders?
The Amplatzer Devices are commonly used to close off defects.These occluders
are inserted through a tube from the leg and implanted in the heart to close
the defect. They are made of surgical grade Dacron and metal alloys.
Left Ventricie
Right Atrium
Right Ventricie
Figure 2: Heart with an Atrial Septal Defect (ASD).
For PDA device closure, it is done using light sedation and only surface
echocardiography.
Amplatzer Septal
Device
Amplatzer Cribriform
Occluder
Amplatzer PFO
Occluder
Amplatzer Duct
Occluder
What Happens Before The Procedure?
A special echocardiogram, called a transesophageal echocardiography (TEE),
will be required for closure of ASD or PFO. This is done by passing a probe
down your throat. Suitability is assessed by looking at the size and the
position of the defect, as well as if there are any other associated congenital
abnormalities in your heart. Once the defect is found suitable for closure,
admission for procedure will be arranged.
What Happens During The Procedure?
Right Atrium
Aorta
The PDA allows a high pressure flow of blood into the lung’s blood vessels.
This causes damage to the lung vessels over time. The damage can become
permanent if the defect is not closed in time or may be a risk factor in
developing bacterial infection of the heart.
What Is A Patent Foramen Ovale (PFO)?
A foramen ovale is a flap-like structure present between the left and right
atrium in all fetus. Normally, the foramen ovale closes off at birth. If the flap
fails to seal up and remains open, it is called a PFO. The open flap may
allow small clots to pass through and travel easily to the brain and cause
a stroke. PFOs are present in 50% of the patients with stroke of no identifiable
cause (cryptogenic stroke).
image on a monitor). The size of the occluder is selected and the defect
is sealed by unfolding the device. This seals the hole completely like a
patch. The procedure usually takes 30 - 45 minutes.
For ASD and PFO device closure, the procedure is usually carried out under
a general anesthesia, which TEE is used to guide the implantation of the
occluder device. A small catheter or tube is passed into the vein of the groin
and passed into the right atrium on the right side of the heart and across
the defect. The size of the defect is measured using a combination of TEE
or fluoroscopy (a type of medical imaging that shows a continuous x-ray
What Happens After The Procedure?
You will then be awakened and monitored in the operating theatre recovery
area before being transferred back to the ward.
You will need to lie flat for 4 – 6 hours after the procedure to avoid
bleeding from the wound. The nurses in the ward will monitor your leg
pulses and the blood pressure to ensure that you are recovering well.
You may start eating and drinking once you feel better.
At times, patients who have undergone general anesthesia may feel
nauseous up to a few hours after the procedure. This is common. Medication
can be given to reduce the nausea.
When You Will Be Discharged
With no complication, you can be discharged a day after the procedure.
The specialist will see you 6 – 8 weeks post procedure. Routine surface
echocardiograms will be done from time to time as part of your followup.