Should an ASD be closed ?

Most doctors would say YES. Recently, a very few cardiologists are questioning the need for ASD closure in some patients, but it is a very uncertain issue. The best way I can put it is, if I had an ASD, I would elect to have it repaired.

When should an ASD be closed ?

Since most children with ASD's are totally without symptoms, it is usual for an ASD to be detected only when the child is examined at school on a routine check-up, or while tests are being done for some other illness. Sometimes, it is detected only in young adulthood.
Although there is no urgency, the closure should be done as soon as possible to avoid even the small risk of heart failure or paradoxic embolism. Preferably, operation is avoided in very small children. On the other hand, in some cases, ASD's cause problems very early in life. One such is the OSTIUM PRIMUM type ASD, which usually has other defects - like mitral valve clefts - associated with it. These children may develop heart failure very early in life, and need surgery sometimes even within the first year of life.

How can ASD's be treated ?

Closure of ASD without any treatment is a "medical curiosity". Most need to be closed by doctors.
Traditionally, closure by operation has been the method that has stood the test of time. By an open heart operation, the hole in the atrial septum is stitched using a special thread made of a polymer material called PROLENE or POLYPROPYLENE. When the ASD is very large, it may have to be closed with a "patch" of material placed over it and stitched in place. This "patch" may be the patient's own tissue - the covering of the heart called PERICARDIUM is commonly used - or a synthetic material like silk cloth or dacron.
When other defects occur in addition, the operation is a little more complex. When the pulmonary veins are opening into the right atrium, they must be re-directed back to the left atrium. When the mitral valve is abnormal, it must be repaired, or in very rare instances, replaced with an artificial valve.

And there are some newer methods developed recently to close ASDs....

 

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