ASD Closure

What this procedure is

An ASD closure is a procedure used to seal a hole in the wall that separates the heart's two upper chambers. This wall is known as the atrial septum. When there is a hole in this wall, it is called an Atrial Septal Defect (ASD).

Your clinician may perform this closure in one of two ways:

• Transcatheter closure: A doctor inserts a thin, flexible tube called a catheter into a blood vessel, usually in the groin. They use the tube to move a small, permanent device into the heart to plug the hole.
• Surgical closure: A surgeon uses stitches or a special medical patch to close the opening during an operation.

The goal of both methods is to stop blood from leaking between the chambers, which helps the heart pump more efficiently.

What it treats or fixes

This procedure treats a condition where blood flows incorrectly between the heart chambers. In a healthy heart, the left side pumps oxygen-rich blood to the body, while the right side sends oxygen-poor blood to the lungs.

If a hole is present, oxygen-rich blood can leak back into the right side. This causes the heart to pump extra blood that it doesn't need to, which can lead to several issues:

• It can cause the right side of the heart to become enlarged or stretched over time.
• It can increase the blood pressure in the lungs, which may cause damage to the lung's blood vessels.
• It may lead to an irregular heartbeat or an increased risk of other heart-related concerns.

Closing the hole helps the heart and lungs work together more effectively and is intended to prevent these long-term complications.

How common it is & where it's done

Atrial Septal Defects are one of the most common heart issues people are born with. They are considered the second most common type of congenital heart defect, which is a heart condition present at birth. While some small holes may close on their own during early childhood, others may persist and require a procedure later in life.

These procedures are usually performed in specialized hospitals or dedicated heart centers. Your care may be managed by a cardiologist, who specializes in heart health, or a cardiothoracic surgeon, who specializes in heart operations.

Because this is a well-established treatment, many medical centers across the United States and Canada have teams specifically trained to perform both catheter-based and surgical closures for patients of all ages.

Recovery: What to Expect

Recovery depends on whether your clinician uses a catheter (a thin, flexible tube) or surgery to close the hole. For many people, a catheter procedure allows for a shorter hospital stay, often just one night. You may feel some mild soreness where the tube was inserted, usually in the groin area.

• Activity: Your team will likely ask you to avoid heavy lifting or intense exercise for a few weeks to let the site heal.
• Medications: You may need to take a daily aspirin or other blood-thinning medicine for several months to prevent small clots from forming on the new closure device.
• Follow-up: Your clinician will use an echocardiogram (an ultrasound of the heart) to make sure the device is in the right spot and the hole is fully sealed.

Risks & Possible Complications

While ASD closure is generally very safe, all medical procedures have some risks. Your care team will monitor you closely for any signs of trouble. Some patients may experience an arrhythmia, which is an irregular heartbeat, shortly after the procedure. This often settles down on its own or with medicine.

Other rare complications can include bleeding at the insertion site or the device moving out of place. You should contact your clinician if you notice:

• A high fever or signs of infection (redness or warmth) at the incision.
• Sudden shortness of breath or chest pain.
• A feeling that your heart is racing or skipping beats.

Outcomes & Long-Term Results

The main goal of closing an ASD is to stop extra blood from flowing into the lungs. Over time, this helps prevent pulmonary hypertension (high blood pressure in the lung arteries) and keeps the right side of the heart from becoming enlarged or weak.

Most people find they have more energy and less shortness of breath during physical activity after they recover. Long-term results are typically excellent, though your clinician may recommend regular check-ups for several years to monitor your heart rhythm and the health of your heart chambers.

Emotional Support & Reassurance

It is completely normal to feel nervous about a heart procedure. Remember that ASD closure is a common and well-studied treatment designed to protect your heart for the long term. Most people return to their normal routines quickly and feel a sense of relief knowing the defect is fixed.

If you feel anxious, your care team is there to help. Asking questions about what to expect on the day of the procedure can help you feel more in control. Many patients find comfort in knowing that this step is a proactive way to ensure a healthier future.

Why doctors recommend it

An Atrial Septal Defect (ASD) is a hole in the wall, or septum, that separates the two upper chambers of the heart. Your clinician may recommend closing this hole if it allows too much blood to "shunt," or leak, from the left side of the heart to the right side. This extra blood flow forces the right side of the heart to work much harder than it should.

While very small holes might only need regular check-ups (monitoring), larger holes usually require a procedure because the heart cannot fix a large hole on its own. If left open, the constant extra work can cause the heart to enlarge or stretch out. Closing the hole helps stop this cycle and protects the heart muscle from being overworked.

Urgent vs planned treatment

For most people, ASD closure is a planned, or elective, procedure. It is rarely considered a medical emergency. In many cases, clinicians will monitor small holes in infants and children to see if they close on their own without surgery. If the hole is still present as the child grows, or if it is discovered in an adult, the team will usually schedule the closure for a time when the patient is in good overall health.

While the procedure is usually scheduled in advance, your clinician may recommend moving forward sooner if there are specific concerns. This might happen if there is a risk of a stroke (caused by a blood clot passing through the hole) or if the heart is showing signs of significant strain. Planning the treatment early helps prevent permanent changes to the heart or lungs.

Goals of treatment

The primary goal of treatment is to restore normal blood flow through the heart. Success means the hole is completely sealed, and the heart no longer has to pump unnecessary blood back into the lungs. This helps the heart maintain a healthy size and shape. Successful treatment aims to:

• Prevent pulmonary hypertension: This is a serious condition where the blood pressure in the lung arteries becomes too high.
• Reduce rhythm problems: Closing the hole can lower the risk of developing irregular heartbeats, also known as arrhythmias.
• Improve daily life: Many patients find they have more energy and less shortness of breath after the procedure.
• Protect long-term health: The procedure is designed to prevent heart failure and other complications that can happen if an ASD is left untreated for many years.

Who may benefit

An Atrial Septal Defect (ASD) is a hole in the wall (septum) that separates the top two chambers of the heart. Your clinician may suggest closing this hole if it is large enough to cause "volume overload." This means too much blood is flowing into the right side of the heart, which can cause it to stretch or work harder than it should.

Adults and children may benefit from this procedure if they experience symptoms like shortness of breath, getting tired easily during exercise, or heart palpitations (the feeling of a racing or fluttering heart). Closing the hole can also help prevent future health problems, such as a higher risk of stroke or certain types of heart rhythm issues later in life.

When it may not be the right option

Closure is not always the best path for every patient. If the ASD is very small and is not causing any strain on the heart, your care team may recommend simply monitoring it with regular check-ups. In many infants, small holes close on their own without any treatment as the child grows.

In some cases, closing the hole could be harmful. This usually happens if a person has developed severe high blood pressure in the lungs, a condition known as pulmonary hypertension. If the blood flow through the hole has reversed direction due to this high pressure, your clinician may decide that keeping the hole open is safer for your heart's overall function.

Questions to ask your care team

It is helpful to talk through your options with your medical team. You may want to ask these questions during your visit to better understand the next steps:

• Based on my tests, how much extra stress is this hole putting on my heart?
• Is my ASD small enough to monitor, or is it likely to cause problems if left alone?
• Am I a candidate for a minimally invasive closure using a catheter (a thin tube), or is surgery required?
• What are the long-term benefits of closing the hole at my age?
• What activities will I be able to do after I have recovered from the procedure?

In the procedure room

The procedure takes place in a specialized area called a cardiac catheterization lab, or "cath lab." This room is equipped with advanced imaging screens and heart monitoring tools. You will be surrounded by a team of specialists, including a cardiologist and nursing staff, who focus on your comfort and safety.

High-level steps

The clinician begins by making a very small opening in the groin to reach the femoral vein. A thin, flexible tube called a catheter is then carefully guided through the vein until it reaches the heart. This process is guided by live images on a monitor.

Once the catheter is in place, a closure device—which often looks like two small connected umbrellas—is pushed through the tube. The clinician opens the device to cover the hole in the heart. After confirming the device is secure and the hole is sealed, the catheter is removed, leaving the device permanently in place.

Anesthesia and pain control

Your clinician may use general anesthesia to ensure you are in a deep sleep and do not feel anything during the procedure. In some cases, they may use sedation, which makes you very sleepy and relaxed. A local anesthetic is also used to numb the skin at the groin where the catheter enters, so you should only feel a bit of pressure or numbing in that area.

Monitoring and safety steps

Safety is a top priority throughout the closure. The team uses an EKG to watch your heart rhythm and monitors your blood pressure and oxygen levels constantly. To see the heart in real-time, they use fluoroscopy (a type of X-ray) and ultrasound, such as a transesophageal echocardiogram (TEE). These tools help the clinician ensure the device is positioned exactly where it needs to be.

Immediately after the procedure

Once the procedure is finished, the clinician removes the catheter and applies firm pressure to the groin area. This is done to help the small vein opening close and to prevent bleeding. You may have a small bandage or dressing placed over the site.

You will be moved to a recovery room where you must lie flat for several hours, usually between four and six hours. This period of bed rest is important to allow the access site in your leg to heal properly. You might feel some mild soreness or see a small bruise, but the team will monitor you closely for any discomfort.

Typical procedure length

The actual closure of the ASD typically takes about 1 to 2 hours. However, you should expect to spend more time in the hospital for preparation before the procedure and for the recovery period afterward. Your care team will give you a better idea of the total time based on your specific needs.

Common approaches (open vs minimally invasive)

Doctors choose the best way to close an atrial septal defect (ASD) based on the size of the hole and where it is located in the heart. The goal is to stop blood from flowing incorrectly between the upper heart chambers.

• Catheter-based repair (Minimally invasive): This is often the first choice for the most common type of ASD (secundum). A clinician inserts a thin, flexible tube called a catheter into a vein in the groin. They guide a closure device through the tube up to the heart. The device acts like a plug or sandwich to seal the hole. This method avoids large incisions and usually has a faster recovery time.
• Surgical repair (Open): Surgery is typically needed for very large holes or specific types of ASDs (such as primum or sinus venosus defects) that cannot be fixed with a catheter device. A surgeon makes an incision in the chest to access the heart directly. They use stitches or a patch made of special material to close the opening.
• Minimally invasive surgery: In some cases, surgeons can perform the repair through smaller cuts on the side of the chest rather than opening the breastbone completely. This option is not available for every patient.

Partial vs total

The primary goal of these procedures is total closure, meaning the hole is completely sealed so no blood leaks through. For most patients, a successful repair stops the extra blood flow to the lungs and reduces strain on the right side of the heart.

In some instances, a tiny amount of leakage may remain immediately after the procedure. This is known as a "residual shunt." Often, the body's own tissue grows over the device or patch over time, which helps seal these small gaps. Your care team will check for any remaining leaks using echocardiograms (heart ultrasounds) during follow-up visits.

Revision or repeat procedures

Most ASD repairs are permanent and do not require further treatment. However, complications can occur that may require a second procedure. For example, if a catheter device moves out of place (embolization) or does not fully seal the hole, doctors may need to intervene again.

If a device fails or causes issues like erosion of the surrounding tissue, surgery might be necessary to remove the device and close the hole with a patch. While repeat procedures are not common, long-term monitoring is important to ensure the repair stays secure and the heart functions well.

Tests and imaging that may be done

Before an ASD closure, your care team needs to understand the exact size and location of the opening in the heart wall. They also check for any other heart conditions that might affect the procedure. Common tests include:

• Transthoracic Echocardiogram (TTE): This is a standard ultrasound of the heart. A wand is placed on your chest to create images using sound waves. It is often the main tool used to find an ASD.
• Transesophageal Echocardiogram (TEE): If clearer pictures are needed, a small ultrasound probe is guided down the throat. This allows the doctor to see the back of the heart and measure the rims of the defect more precisely.
• Electrocardiogram (ECG or EKG): This test records the electrical activity of your heart to check for rhythm issues or signs of strain on the right side of the heart.
• Chest X-ray: This creates a picture of the heart and lungs to see if the heart is enlarged or if there is extra blood flow in the lungs.

In some cases, if the ultrasound does not provide enough detail, a cardiac MRI or CT scan may be used to create a 3D view of the heart structure.

Medication adjustments

Your doctor will review all the medicines, vitamins, and supplements you currently take. Because ASD closure involves blood vessels and heart tissue, managing how your blood clots is important.

You may need to adjust specific medications before the procedure, but this varies for every patient. General guidelines often include:

• Blood thinners: If you take anticoagulants or antiplatelet medicines, your doctor will tell you if or when to pause them to reduce the risk of bleeding.
• Daily medications: Ask which pills you should take on the morning of the procedure with a small sip of water.

Important: Only stop medicines if your clinician instructs you. Do not make changes to your routine without their specific guidance.

Day-before and day-of instructions

ASD closure is typically performed using a catheter inserted through a vein in the groin (femoral vein), or sometimes through surgery. Your care team will give you a specific plan to prepare your body for the anesthesia or sedation used during the repair.

Common instructions include:

• Fasting: You will likely be told not to eat or drink anything for a certain number of hours before your arrival time. This keeps your stomach empty for anesthesia safety.
• Hygiene: You may be asked to shower with a special soap the night before or morning of the procedure to lower the risk of infection.
• Arrival: The hospital will tell you when to arrive to allow time for check-in and final preparation.

Once you are at the hospital, the team will prepare the insertion site (usually the groin area) by cleaning and possibly shaving the skin. They will also place an IV line to deliver fluids and medications during the procedure.

General surgical risks

ASD closure is generally considered safe, and serious problems are rare. However, like any medical procedure, there are standard risks involved. For patients having a catheter-based procedure, the most common issue is bruising, bleeding, or soreness at the entry site (usually the groin) where the doctor inserts the tube.

For those undergoing surgical closure, risks can include infection at the incision site or reactions to anesthesia. Your care team takes many precautions to prevent infection and monitors your vital signs closely throughout the process to manage these risks.

Procedure-specific complications

While complications are uncommon, there are specific issues related to closing the hole in the heart. These can include:

• Heart rhythm changes: You may experience an irregular heartbeat (arrhythmia), such as atrial fibrillation. This often happens because the heart tissue is adjusting to the device or patch.
• Device issues: In very rare cases (less than 1%), a closure device placed by catheter might move out of its proper position (embolization) or rub against the heart wall (erosion).
• Fluid buildup: Some patients, especially those having surgery, may develop fluid around the heart (pericardial effusion).
• Clots: There is a small risk that a blood clot could form on the device or patch before the body heals over it.

How complications are treated

Most complications are treatable and temporary. To prevent blood clots, your clinician will likely prescribe blood-thinning medication (such as aspirin) for about six months after the procedure. This medicine protects you while your own heart tissue grows over the device or patch to seal it permanently.

If an irregular heartbeat occurs, it can often be managed with medication. Doctors use follow-up imaging tests, such as echocardiograms, to ensure the device stays in the correct position. In the very rare event that a device moves, doctors can usually retrieve it using a catheter or, if necessary, perform surgery to fix the issue.

Pain control medicines

After an ASD closure, it is common to have some mild discomfort or soreness near the site of the procedure. Your clinician may suggest over-the-counter pain relievers to help you stay comfortable during your recovery. These often include medicines like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Your care team will tailor the choice of medicine to your specific needs. They will consider your medical history and any other health conditions you may have. It is important to tell your clinician about any allergies you have to pain medications before starting them to ensure they are safe for you.

Antibiotics

Antibiotics are medicines used to prevent or treat infections. After a device is placed to close an ASD, the heart needs time to grow a natural layer of tissue over it. During this healing period, your clinician may recommend what is called "endocarditis prophylaxis." This involves taking antibiotics before certain dental or medical procedures to prevent a rare heart infection.

This extra protection is usually recommended for about six months after the procedure while the heart heals. Your clinician will provide specific instructions on when you might need these medicines. Always let your healthcare providers and dentist know you have a heart device, and be sure to report any known antibiotic allergies.

Blood thinners and clot prevention

To help the heart heal smoothly, clinicians often prescribe medicines that prevent blood clots. These are sometimes called "blood thinners" or antiplatelet medicines. They help stop blood cells from sticking to the new closure device while the body heals around it.

• Aspirin: This is one of the most common medicines used for several months after the procedure to keep the device clear of clots.
• Other antiplatelet medicines: In some cases, your clinician may add a second medicine, such as clopidogrel, to provide extra protection.

Your clinician will decide the exact type and length of time you need these medicines, often lasting for at least six months. Because these drugs can affect how your blood clots, you should watch for unusual bruising or bleeding. Be sure to discuss any other medications or supplements you take with your team to avoid potential interactions.

Emergency warning signs

While serious complications after ASD closure are rare, immediate care is required if they occur. Call emergency services (911) or go to the nearest emergency room if you observe signs of a stroke or severe heart distress.

• Stroke symptoms: Sudden weakness or numbness (especially on one side of the body), slurred speech, confusion, or vision changes.
• Severe chest pain: Sudden or crushing pain in the chest that does not go away.
• Breathing difficulties: Sudden shortness of breath or struggling to breathe while resting.
• Loss of consciousness: Fainting or passing out.

Call your surgeon or clinic if…

Contact your healthcare provider if you notice new symptoms that are not life-threatening but concern you. Your clinician can determine if you need to be seen for an evaluation.

• Irregular heartbeats: Sensations of a racing, fluttering, or skipping heartbeat (arrhythmias) that persist.
• Signs of infection: A fever, chills, or increasing redness, warmth, or drainage at the incision or catheter site.
• Bleeding issues: A lump under the skin or bleeding at the catheter site (usually the groin) that does not stop with pressure.
• Swelling: New or worsening swelling in the legs, ankles, or abdomen.

Expected vs concerning symptoms

Recovery involves a healing process, and distinguishing between normal recovery and potential complications is helpful.

• Expected: It is common to feel tired and experience mild soreness or small bruises at the procedure site. These symptoms typically improve steadily over a few days to weeks.
• Concerning: Pain that gets worse despite taking medication, bruising that spreads rapidly, or symptoms that return after you had started feeling better.

Your healthcare team will provide specific discharge instructions. If you are unsure whether a symptom is normal, contact your clinic for guidance.

Non-surgical treatments

For many people, a hole in the heart (ASD) can be fixed without traditional open-heart surgery. The most common non-surgical method is called a transcatheter closure. During this procedure, a clinician inserts a thin, flexible tube called a catheter into a blood vessel, usually in the groin, and guides it to the heart. A small, umbrella-like device is then placed to plug the hole.

While medications cannot close the hole itself, your clinician may prescribe them to manage symptoms. These might include medicines to help the body get rid of extra fluid or to keep the heart rhythm steady. These treatments focus on keeping the heart healthy while the defect is being monitored.

Watchful waiting

If an ASD is very small and not causing symptoms, your clinician may suggest watchful waiting. This means the medical team will monitor the heart closely over time rather than performing a procedure right away. In many infants and young children, small holes may even close on their own as the heart grows naturally.

During this period, you will likely have regular check-ups with a cardiologist, a doctor who specializes in the heart. These visits often include an echocardiogram, which is a painless ultrasound used to see how blood is flowing through the heart. This helps the team ensure the heart is not working too hard or becoming enlarged.

When surgery becomes the best option

Surgery may be recommended if the hole is too large to be closed with a catheter device or if it is located in a spot that does not have enough of a "rim" to hold a plug in place. Your clinician may also suggest surgery if there are other heart issues that need to be fixed at the same time.

The decision to move from monitoring to surgery often depends on how the heart is handling the extra blood flow. Common triggers for surgery include:

• The right side of the heart becoming enlarged or strained.
• Increased blood pressure in the lung arteries.
• Symptoms like unusual tiredness or shortness of breath during daily activities.

Fixing the defect helps prevent long-term complications, such as heart rhythm problems or heart failure, later in life. Your medical team will help determine the best timing based on the size of the hole and your overall health.

Hospital services that commonly perform this surgery

ASD closure is usually performed in hospitals that have specialized heart centers. You will likely interact with the Cardiology department, where doctors focus on heart health. Within this department, interventional cardiologists often perform the procedure using a catheter (a thin, flexible tube). If a traditional surgery is needed, cardiothoracic surgeons will lead the care team.

For younger patients, these services are typically found in a pediatric heart center. These centers are designed specifically for children and have teams trained to handle heart issues present from birth, known as congenital heart defects. Your clinician may also involve specialized imaging teams who use ultrasound or other tools to look at the heart before and during the procedure.

Patient resources and support services

Many hospitals provide extra help to make the process easier for you and your family. Cardiac rehabilitation is a common resource; it is a program that helps you safely return to physical activity and improve your heart health after the closure. Social workers are often available to help with emotional support or to help you find local resources.

Other helpful services may include:

• Financial counseling to help you understand insurance coverage and costs.
• Patient educators who explain the procedure and what to expect during recovery.
• Support groups where you can talk to other people who have had similar heart procedures.

Questions for choosing where to have surgery

Choosing where to have your procedure is an important step. You may want to ask your clinician or the hospital staff specific questions to feel more comfortable with your choice. A facility with a lot of experience in treating congenital heart defects is often a good option.

Consider using this checklist when talking to a hospital:

• How many ASD closures does this team perform every year?
• Do you have a specialized team that focuses on congenital heart defects?
• What are the hospital’s success rates for this specific procedure?
• Will I have a dedicated coordinator to help me schedule appointments and follow-up care?
• What kind of support is available if I have questions after I go home?

Conditions commonly treated by this procedure

An Atrial Septal Defect (ASD) closure is primarily used to fix a hole in the wall, or septum, that separates the two upper chambers of the heart. This wall is meant to keep oxygen-rich blood from mixing with oxygen-poor blood. When a hole is present, it can cause the heart to work harder than it should. Your clinician may recommend this procedure for different types of defects, such as a secundum ASD, which is the most common type located in the middle of the wall.

Other conditions that can be associated with or prevented by this procedure include:

• Right-sided heart enlargement: When extra blood flows through the hole, the right side of the heart can become stretched or overworked over time.
• Pulmonary hypertension: This is high blood pressure in the lung arteries, which can happen if the heart sends too much blood to the lungs for many years.
• Atrial arrhythmias: These are irregular heart rhythms, like atrial fibrillation, that may develop when the heart chambers are under stress or become enlarged.

Related symptoms people search for

Many people with a small hole in the heart may not notice any signs for years, and some defects are only found during a routine checkup. However, as a person gets older, certain symptoms may become more noticeable. These symptoms can be associated with the heart and lungs working harder to move blood through the body. If you notice these signs, your clinician may suggest an evaluation to see if an ASD is the cause.

Common symptoms people often search for include:

• Shortness of breath: You might feel winded more easily than usual, especially when you are being active or exercising.
• Fatigue: Feeling unusually tired or having low energy, even when you have had enough rest.
• Palpitations: A feeling that your heart is skipping a beat, fluttering, or racing in your chest.
• Swelling: Some people may notice mild swelling in their legs, feet, or abdomen, which can be a sign of heart strain.

In some cases, a clinician may look for an ASD if a patient has experienced a stroke with no other clear cause. This is because a tiny blood clot could potentially pass through the hole and travel toward the brain. It is important to discuss any of these concerns with a healthcare professional to determine the best course of action for your heart health.

Evidence overview

Medical research has established ASD closure as a standard and effective treatment for significant heart defects. Evidence shows that closing a large atrial septal defect can prevent serious long-term complications, such as heart failure, stroke, and high blood pressure in the lungs (pulmonary hypertension). Studies indicate that when the procedure is performed in childhood or early adulthood, patients often enjoy a life expectancy similar to that of the general population.

For many patients, particularly those with the most common type of ASD (secundum), catheter-based closure is supported by data showing high success rates and faster recovery times compared to open-heart surgery. However, surgery remains a proven and safe method for complex defects that cannot be fixed with a catheter device. Your care team relies on these established guidelines to determine the best approach for your specific anatomy.

Safety notes and individualized care

ASD closure is generally considered a safe procedure with a very low risk of life-threatening complications. However, as with any medical intervention, there are potential risks that your doctor will discuss with you. These risks can vary depending on whether you undergo a catheter procedure or surgery.

Possible risks may include:

• Heart rhythm issues: Some patients may experience arrhythmias, such as atrial fibrillation, after the procedure.
• Bleeding or infection: These can occur at the site where the catheter was inserted (usually the groin) or at the surgical incision.
• Device complications: In rare cases involving catheter closure, the device used to plug the hole may move or irritate surrounding tissue.

Not every ASD requires closure. Small defects often close on their own during childhood or may not cause enough strain on the heart to require treatment. Your clinician will evaluate the size of the defect and check for signs of heart enlargement before recommending a procedure. This individualized approach ensures that closure is only performed when the benefits clearly outweigh the risks.