{"id":1379,"date":"2020-04-03T16:02:00","date_gmt":"2020-04-03T14:02:00","guid":{"rendered":"http:\/\/aritmije.kbcsm.hr\/?p=1379"},"modified":"2020-04-09T00:51:39","modified_gmt":"2020-04-08T22:51:39","slug":"atrial-septal-defect-closure","status":"publish","type":"post","link":"https:\/\/aritmije.kbcsm.hr\/en\/atrial-septal-defect-closure\/","title":{"rendered":"Atrial septal defect closure"},"content":{"rendered":"<div id='av_section_1'  class='avia-section alternate_color avia-section-huge avia-no-shadow  avia-full-stretch av-section-color-overlay-active avia-bg-style-scroll  avia-builder-el-0  el_before_av_two_third  avia-builder-el-first   container_wrap sidebar_right' style='background-repeat: no-repeat; background-image: url(https:\/\/aritmije.kbcsm.hr\/wp-content\/uploads\/2020\/03\/aritmije-kbcsm-header_5.jpg);background-attachment: scroll; background-position: top center;  '  data-section-bg-repeat='stretch'><div class='av-section-color-overlay-wrap'><div class='av-section-color-overlay' style='opacity: 0.7; background-color: #000000; '><\/div><div class='container' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-1379'><div class='entry-content-wrapper clearfix'>\n<div class='flex_column_table av-equal-height-column-flextable -flextable' ><div class=\"flex_column av_three_fourth  flex_column_table_cell av-equal-height-column av-align-middle av-zero-column-padding first  avia-builder-el-1  avia-builder-el-no-sibling  \" style='border-radius:0px; '><div  style='padding-bottom:0px; font-size:70px;' class='av-special-heading av-special-heading-h1  blockquote modern-quote  avia-builder-el-2  avia-builder-el-no-sibling  av-inherit-size '><h1 class='av-special-heading-tag '  itemprop=\"headline\"  >Atrial septal defect closure (ASD)<\/h1><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n<\/div><\/div><\/main><!-- close content main element --><\/div><\/div><\/div><div id='after_section_1'  class='main_color av_default_container_wrap container_wrap sidebar_right' style=' '  ><div class='container' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-1379'><div class='entry-content-wrapper clearfix'>\n<div class=\"flex_column av_two_third  flex_column_div av-zero-column-padding first  avia-builder-el-3  el_after_av_section  el_before_av_one_third  avia-builder-el-first  \" style='border-radius:0px; '><section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock  '   itemprop=\"text\" ><p style=\"text-align: justify;\">Atrial septal defect (ASD) is a hole in the muscular wall (<em>interatrial septum) <\/em>between the two upper chambers of the heart (<em>atrium)<\/em>. Such deficiency leads to communication between both atria, which, if sufficiently large, can lead to a reversal of blood flow and consequently to many disorders such as heart failure, pulmonary hypertension, stroke, heart rhythm disturbances.<\/p>\n<p style=\"text-align: justify;\">It is one of the most common congenital heart defects. There are many forms of defect, but the most common is the so-called <em>type secundum<\/em>, in which the described communication is located at the very middle of the septum.<\/p>\n<p style=\"text-align: justify;\">Diagnosis is often made during adulthood because patients have no symptoms or have minimal symptoms.<\/p>\n<p style=\"text-align: justify;\">For the last several decades, the treatment has been purely surgical, but today the method of percutaneous defect closure is being used with the help of so-called occluder, which is also available at our institution since 2018.<\/p>\n<p style=\"text-align: justify;\"><strong>Procedure<\/strong><\/p>\n<p style=\"text-align: justify;\">Prior to the procedure, each patient is fully explained the benefits and potential risks of the procedure (informed consent of the patient). It should be noted that before and after the procedure, it is mandatory to take dual anti-aggregation therapy (acetylsalicylic acid plus clopidogrel) for a minimum of 3 months, due to the risk of thrombosis of the device. Prophylaxis of bacterial endocarditis is also required up to 6 months after surgery.<\/p>\n<p style=\"text-align: justify;\">As part of the preparation for the procedure, a transesophageal ultrasound (TEE) is performed to determine in more detail the characteristics of the septal defect itself for better planning of the intervention (type of defect, size, anatomic borders). The same method excludes the existence of a thrombus in the left atrial appendage.<\/p>\n<p style=\"text-align: justify;\">The procedure is performed by introducing a catheter via the groin vein, with previous local anesthesia of the injection site and intravenous titration of the analgosedation. The catheter is \u00a0then placed first through the vein into the right atrium and then through the atrial septal defect into the left atrium. An ultrasound probe (TEE) is also placed in the esophagus during the procedure, through which the optimum position of the occluder can be clearly visualized, as well as early complications of procedure (alternatively, an intracardiac ultrasound can be placed via another groin vein).<\/p>\n<p style=\"text-align: justify;\">When the sheath is positioned in an adequate anatomic location, the occluder is slowly released until it &#8216;sits&#8217; on the septum defect. The septal occluder use din our center consists of two disks composed of nitinol and polyester, which are interconnected by a short central part that completely fills the defect. The very composition of the occluder enhances the process of closing the defect in such a way that in the weeks after the procedure it stimulates the device to grow into cardiac tissue, which definitely closes the defect.<\/p>\n<p style=\"text-align: justify;\">The success rate of the procedure is extremely high (98% successfully closed ASD 12 months after the procedure) with a low risk of complications (<1%).<\/p>\n<p style=\"text-align: justify;\">The day after the procedure, a control transthoracic ultrasound of the heart is performed, and it should be repeated within the control monitoring 3 months after the procedure.<\/p>\n<p style=\"text-align: justify;\">The patient is most often discharged home day after the procedure if the postprocedural course is uneventful.<\/p>\n<\/div><\/section><\/div><div class=\"flex_column av_one_third  flex_column_div av-zero-column-padding   avia-builder-el-5  el_after_av_two_third  el_before_av_hr  \" style='border-radius:0px; '><div  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