Nonsurgical Closure – The Basic Technique

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• Avoid surgery i nvsd
• avoid surgery in asd
• Device closures of hear holes

Device closures are usually tried after child has good weight like 6-7 Kg.

We have large vessels in our groin called Femoral Artery and Femoral Vein. A needle is first introduced into these two vessels (something like starting a saline drip). Next cardiac catheters are passed through these vessels and they reach the heart. We take the intracardiac pressure and anatomic data from these catheters. Then we inject radicontrast to outline the hole. Simultaneous echocardiography and fluoroscopy is done to confirm the findings. Then a nitinol(nickel- titanium alloy) device or button is delivered to the site of the hole and finally it is released. Post procedure angiography and echocardiography is done to confirm everything is OK. Then all catheters are taken out and only the device stays inside the heart.

All this is done under general anesthesia so that the baby does not feel anything. Post procedure , baby is taken to the pediatric ICU, slowly taken out of anesthesia and monitored for 24 hours. Next day, he/ she undergoes another echo and discharged home.

Preparation of the child before Device Closure:

The child is admitted the evening before. Some basic  investigations like blood tests(hemogram, urea, creatinine, serology ), Chest X Ray and ECG are done. An anesthesist checks the baby for fitness and starts saline. The child has to fast for a minimum of four hours before the procedure.

Post Device Closure: What to Expect?

1. Your child will be in pediatric ICU till he is conscious, breathing normally, blood pressure and heart rate stabilizes and he is able to take oral feeds. Usually this takes 4-6 hours but may vary from child to child.
2. There will be a bandage covering the groin. The baby should not walk or bend that leg for 24 hours. Next day he can walk.
3. Echocardiography and Xray next day.
4. The baby is started on medicines to prevent clot inside the heart. This is called Aspirin and given once daily for 3-6months.
5. The baby is advised not to carry any heavy load and avoid direct trauma to the chest for three months only.
6. This three months is the time taken for the heart to develop endothelium lining around the device so that the device becomes a part of the body.
7. Schedule of follow up in  cardiology OPD:

Ist visit : 1 month later

2^nd visit: 3 months later

3^rd visit: 6 months later

Thereafter annual visits

Device Closure in Detail

Atrial Septal defect Device Closure

Ventricular Septal Defect Device Closure

Patent Ductus Arteriosus (PDA) Device Closure

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