Understanding your heart procedure.

Holes in the heart

Some people are born with an opening between the chambers of the heart, or with a blood vessel that should have closed after birth. These are among the most common heart conditions present at birth.

• Atrial septal defect (ASD) — an opening in the wall (septum) between the two upper chambers of the heart, the atria.
• Ventricular septal defect (VSD) — an opening in the wall between the two lower chambers, the ventricles. A muscular VSD lies in the muscular part of that wall.
• Patent ductus arteriosus (PDA) — before birth, a blood vessel called the ductus arteriosus connects the aorta and the pulmonary artery. It normally closes shortly after birth; if it stays open, it is called “patent”.

Closing the opening with an occluder

Many of these openings can be closed without open-heart surgery, using a transcatheter procedure in a catheterisation laboratory (cath lab):

1. A thin, flexible tube (catheter) is passed into a blood vessel, usually in the groin, and guided to the heart using X-ray and ultrasound imaging.
2. The occluder — a small, folded device made of nitinol wire mesh — is pushed through the catheter to the opening.
3. As it leaves the catheter, the occluder expands to its shape and closes the opening. The doctor checks its position before releasing it.
4. Over the following months, the body’s own tissue grows over the device.

Not every opening is suitable for device closure. Your cardiologist decides based on the size and position of the defect, and your overall health.

Coronary angioplasty (PTCA)

Coronary artery disease happens when the arteries that supply the heart muscle become narrowed. Percutaneous transluminal coronary angioplasty (PTCA), part of percutaneous coronary intervention (PCI), widens a narrowed artery without open surgery:

1. A catheter is passed through an artery in the wrist or groin to the heart, and dye is injected so the arteries can be seen on X-ray (angiography).
2. A very thin guidewire is passed across the narrowing.
3. A small balloon on a catheter is moved along the wire and inflated to widen the artery. A stent (a small mesh tube) is often placed to help keep it open.

Questions to ask your doctor

• Is a catheter procedure suitable for me, and what are the alternatives?
• What are the risks and benefits in my case?
• How long will I stay in hospital, and when can I return to normal activity?
• What medicines will I need afterwards, and what follow-up is planned?