ASD Device Closure
in Hyderabad

Types of ASD

What this means for you

Only secundum ASDs — the most common type — are suitable for catheter-based device closure. Before recommending the procedure, Dr. Bhishma Chowdary confirms the defect type, size, and tissue border adequacy with a detailed echocardiogram. If your ASD is a primum or sinus venosus type, surgical referral will be recommended.

When does an ASD need to be closed?

Not all ASDs require intervention. Small ASDs (less than 5 mm) may never cause symptoms and do not require closure. Spontaneous closure occurs in some infants and young children with small defects. However, closure is recommended when:

• The defect is causing significant left-to-right shunting — quantified by a pulmonary-to-systemic flow ratio (Qp:Qs) greater than 1.5:1
• Right heart enlargement is present on echocardiography — even without symptoms
• Symptoms are present: breathlessness on exertion, reduced exercise tolerance, fatigue, or palpitations
• A paradoxical embolism or cryptogenic stroke has occurred — blood clots can cross from right to left through the ASD, reaching the brain
• Atrial arrhythmias (atrial fibrillation or flutter) have developed in association with right heart dilatation
• Pulmonary hypertension is developing — closure is recommended before irreversible pulmonary vascular changes occur

ASD in adults — a frequently missed diagnosis

Many adults with ASD are diagnosed only in their 30s, 40s, or 50s — sometimes after years of unexplained breathlessness, recurrent chest infections, or investigation for an irregular heartbeat. It is never too late to benefit from closure in adults who do not yet have severe pulmonary hypertension. Dr. Bhishma Chowdary sees many adult patients with newly diagnosed ASD and provides a clear assessment of whether closure is indicated and beneficial.

How is ASD device closure performed? Step by step

Pre-procedure evaluation

• Transthoracic echocardiogram (TTE) — confirms ASD type, estimates defect size, and assesses right heart dimensions and function.
• Transesophageal echocardiogram (TOE/TEE) — the most important pre-procedure imaging. Precisely measures the defect diameter in multiple planes, evaluates all four tissue borders (aortic, posterior, inferior, and superior rims), and rules out associated anomalies. Essential for device selection.
• Bubble contrast study — agitated saline injected intravenously to confirm right-to-left shunting across the defect.
• Cardiac CT in selected cases — used when TOE findings are inconclusive or for complex anatomy.
• Pulmonary function tests and right heart catheterisation if pulmonary hypertension is suspected — to confirm suitability for closure.

On the day of the procedure

1. You are admitted and prepared. Fasting for 4 to 6 hours. IV access, ECG monitoring, and blood tests completed.
2. Anaesthesia is administered — either conscious sedation (local anaesthesia at the groin + IV sedation) or general anaesthesia. General anaesthesia is more common for ASD closure as it allows optimal TOE imaging and patient cooperation.
3. A transesophageal echocardiogram (TOE) probe is placed — providing real-time imaging of the heart and ASD throughout the procedure.
4. The right femoral vein in the groin is accessed. A long sheath is advanced through the femoral vein, across the ASD, and into the left atrium.
5. A sizing balloon may be passed across the defect and inflated to measure the stretched diameter of the ASD — this confirms the final device size to be used.
6. The chosen closure device — typically an Amplatzer Septal Occluder or equivalent — is loaded onto the delivery cable and advanced through the sheath into the left atrium.
7. The left atrial disc of the device is deployed first, gently pulled back against the left atrial surface of the septum, then the right atrial disc is deployed on the right side. The device now sits like a double-layered button across the defect.
8. TOE and fluoroscopy confirm correct device position — both discs are flat against the septum, the device is stable, there is no impingement on adjacent structures (mitral valve, aorta, vena cavae), and there is minimal or no residual shunting.
9. The device is released from the delivery cable. The sheath is removed and the venous access site is compressed.
10. You are transferred to the ward for monitoring. The TOE probe is removed.

After the procedure

• Monitored on the cardiac ward overnight. ECG monitoring for any arrhythmias.
• A transthoracic echocardiogram is performed before discharge to confirm device position and absence of pericardial effusion.
• Most patients are discharged on day 2.
• Antiplatelet therapy: Aspirin (75–100 mg daily) plus clopidogrel for 3 to 6 months while endothelialisation of the device occurs, then aspirin alone for a further 6 months. Total antiplatelet duration approximately 12 months.
• Antibiotic prophylaxis before dental and invasive procedures for 6 months after implantation — while the device surface is becoming covered by heart tissue.

What happens to the device after implantation?

The Amplatzer and equivalent devices are made from a nitinol wire mesh — a shape-memory alloy that is biocompatible and well-tolerated by the body. Within the first 24 hours, a thin layer of fibrin forms over the device. Over the following 3 to 6 months, the body's own endothelial cells grow progressively over the device surface — a process called endothelialisation — until the device is completely covered and incorporated into the heart wall. At this point the closure is permanent and no further antiplatelet therapy is needed.

Long-term durability

ASD device closure has an excellent long-term track record with over 25 years of follow-up data available for the Amplatzer device family. Device-related complications beyond the immediate post-procedure period are rare. The closed defect does not reopen. Most patients require only annual or biennial echocardiography long-term to confirm continued good function of the right side of the heart.

ASD device closure versus open-heart surgery

Preparing for your coronary angiogram

Before the day

• Inform your cardiologist of all medications you are currently taking, including blood thinners, diabetes medications, and kidney medications.
• If you are taking metformin for diabetes, it may need to be stopped 48 hours before the procedure due to the contrast dye.
• If you have a known allergy to contrast dye or iodine, inform your cardiologist in advance — pre-medication can be given.
• Arrange for someone to drive you home, as you will not be allowed to drive after sedation.

Frequently asked questions

Can ASD be diagnosed for the first time in adulthood?

Yes — and it is more common than many people realise. Small ASDs may produce no symptoms for decades. Many adults are diagnosed incidentally during echocardiography for another reason, or investigated for unexplained breathlessness, palpitations, or a cryptogenic (unexplained) stroke. An ASD discovered in adulthood can still be treated successfully with device closure provided pulmonary hypertension has not become irreversible. Age alone is not a contraindication to ASD closure.

How do I know if my ASD is suitable for device closure?

Suitability depends primarily on the defect type and the adequacy of the tissue borders surrounding it. Dr. Bhishma Chowdary assesses this with a detailed transesophageal echocardiogram (TOE). Key requirements for device closure are: secundum type ASD, stretched diameter typically less than 38 mm, and adequate tissue rims of at least 5 mm on most borders. Deficient aortic rim alone is not a contraindication with experienced operators. If anatomy is unsuitable, surgical referral will be recommended.

Will I feel the device inside my heart?

No. The closure device is small, sits flush against the septal wall, and is not felt by the patient. Most people have no awareness of the device whatsoever after recovery. Over months, the device becomes covered with the body's own tissue and is functionally indistinguishable from the natural heart wall.

Will the ASD closure improve my symptoms?

Most patients with significant left-to-right shunting experience meaningful improvement in breathlessness and exercise tolerance within weeks to months of closure. Right heart enlargement — which develops over years from volume overload — typically reduces progressively on echocardiography over 6 to 12 months as the right ventricle recovers. Patients who had atrial arrhythmias before closure may still require ongoing treatment for those separately, though the arrhythmia burden often improves after the right heart volume normalises.

Does the device set off metal detectors at airports?

No. Nitinol — the alloy used in ASD closure devices — is non-ferromagnetic and does not trigger airport metal detectors or security scanners. You do not need to carry any special card for airport security for this reason. However, you should carry a card or letter confirming your cardiac procedure for any future MRI or medical procedures.

Can I have an MRI with an ASD closure device?

Yes. Amplatzer and equivalent ASD closure devices are MRI-conditional — they can safely undergo MRI scanning at 1.5 Tesla and 3 Tesla field strengths. No special protocols are required once the device has been implanted for more than 6 weeks. Always inform the radiology team of your device before any MRI.

What is the risk of stroke after ASD device closure?

Paradoxical embolism — where a clot from the venous system crosses the ASD and reaches the brain — is one of the reasons ASD closure is recommended. After successful device closure, this risk is eliminated. During the first few months after implantation, there is a small theoretical risk of clot formation on the device surface before complete endothelialisation, which is why antiplatelet therapy is prescribed for 6 to 12 months. Aspirin and clopidogrel together reduce this risk to very low levels.

Why choose Dr. Bhishma Chowdary for ASD device closure in Hyderabad?

• Dedicated structural heart programme at AIG Hospitals — TAVR, MitraClip, ASD closure, and PFO closure under one team
• Transesophageal echocardiography expertise — TOE guidance for all ASD closures, including 3D TOE for complex anatomy
• International presentations in structural heart intervention: Transcatheter Mitral Valve-in-Valve — TCTAP
• Multidisciplinary Heart Team — complex or borderline cases discussed with cardiac surgery before proceeding
• Experience with adult ASD diagnosis and closure — including patients with longstanding undetected defects and early pulmonary hypertension
• Cardiac CT and cardiac MRI available at AIG Hospitals for complex pre-procedure planning
• Fluent consultations in English, Hindi, and Telugu

Book an ASD device closure consultation in Hyderabad

If you have been diagnosed with an atrial septal defect — or have unexplained breathlessness, palpitations, or have been told you had a cryptogenic stroke — contact Dr. Bhishma Chowdary at AIG Hospitals, Gachibowli, Hyderabad for a specialist structural heart assessment.

Call: +91-9000352998

Email: bhishmachowdary@gmail.com

Location: AIG Hospitals, Gachibowli, Hyderabad — 500032

Clinic hours: Monday to Saturday, 10:00 AM to 4:00 PM

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