02Aug
10 min readASD Closure Surgery in India
ASD Closure Surgery cost in India ranges between USD 4900 to USD 5500.
What is ASD Closure surgery?
An ASD closure is a procedure to close an atrial septal defect (ASD). ASD occurs when part of the septum, the tissue that separates your upper two heart chambers (atria), doesn't form properly. This causes a hole in your heart that doesn't close on its own.
Specialists in Penn Medicine's Interventional Cardiology Program close an atrial septal defect with a minimally invasive technique called cardiac catheterization. They use a thin, hollow tube (catheter) inserted in the groin and threaded up to the heart to place an ASD closure device that plugs the hole. This approach is also called transcatheter ASD closure.
How to prepare patient for ASD closure surgery?- Approx cost of the diagnostic investigation before the AVR surgery is 300USD
Your care team will give you specific instructions to prepare for an ASD closure. They may instruct you to stop taking certain medications, such as blood thinners, for a short period before the procedure. You'll need to stop eating or drinking around midnight on the day before an ASD closure.
You may have a few tests before the procedure to evaluate your heart and provide clear images of the ASD to guide the repair:
- Chest X-ray to look at your heart's structure
- Doppler ultrasound to assess how blood flows through your heart
- Echocardiogram to look at your heart's anatomy and blood flow
- Electrocardiogram to check your heart rhythm
- What is heart catheterization?
Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes. Coronary catheterization is a subset of this technique, involving the catheterization of the coronary arteries.
A small puncture is made in a vessel in the groin, the inner bend of the elbow, or neck area (the femoral vessels or the carotid/jugular vessels), then a guidewire is inserted into the incision and threaded through the vessel into the area of the heart that requires treatment, visualized by fluoroscopy or echocardiogram, and a catheter is then threaded over the guidewire. If X-ray fluoroscopy is used, a radiocontrast agent will be administered to the patient during the procedure. When the necessary procedures are complete, the catheter is removed. Firm pressure is applied to the site to prevent bleeding. This may be done by hand or with a mechanical device. Other closure techniques include an internal suture. If the femoral artery was used, the patient will probably be asked to lie flat for several hours to prevent bleeding or the development of a hematoma. Cardiac interventions such as the insertion of a stent prolong both the procedure itself as well as the post-catheterization time spent in allowing the wound to clot.
A cardiac catheterization is a general term for a group of procedures that are performed using this method, such as coronary angiography. Once the catheter is in place, it can be used to perform a number of procedures including angioplasty, angiography, and balloon septostomy.
Signs and Symptoms of ASD
Many babies who are born with atrial septal defects (ASDs) have no signs or symptoms. When signs and symptoms do occur, heart murmur is the most common. A heart murmur is an extra or unusual sound heard during a heartbeat.
Often, a heart murmur is the only sign of an ASD. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs. Doctors can listen to heart murmurs and tell whether they’re harmless or signs of heart problems.
Over time, if a large ASD isn’t repaired, the extra blood flow to the right side of the heart can damage the heart and lungs and cause heart failure. This doesn’t occur until adulthood. Signs and symptoms of heart failure include:
- Fatigue (tiredness)
- Tiring easily during physical activity
- Shortness of breath
- A buildup of blood and fluid in the lungs
- A buildup of fluid in the feet, ankles, and legs
- How the heart work with an atrial septal defect
The left atrium is normally at a higher pressure than the right atrium. The atrial septal defect allows blood to flow from the left atrium to the right atrium. The blood shunted across the ASD is re-circulated back to the lungs. As seen in figure 2.2, some red blood returning from the lungs into the right upper heart chamber (right atrium) now can flow across the ASD to mix with the blue blood, which is then re-circulated to the lungs. Compare this to the normal heart in figure 2.3, where there is no ASD and no mixing of the red and blue blood.
The effects of having "extra" blood flowing across the ASD into the right atrium and subsequently into the right ventricle and then re-circulated to the lungs are:
The right-sided upper heart chamber (right atrium) and right-sided lower heart chamber (right ventricle) become dilated to accommodate this extra blood volume.
The lungs becomes more "wet" or even become "flooded" with this extra re-circulated blood.
The blood pressure in the lungs increases.
The degree to which these effects occur would depend on the size of the ASD and the amount of blood that is re-circulated back to the lungs. This can range from insignificant to severe.
Risk factors
It’s not known why atrial septal defects occur, but some congenital heart defects appear to run in families and sometimes occur with other genetic problems, such as Down syndrome. If you have a heart defect, or you have a child with a heart defect, a genetic counselor can estimate the odds that future children will have one.
Some conditions that you have during pregnancy can increase your risk of having a baby with a heart defect, including:
Rubella infection. Becoming infected with rubella (German measles) during the first few months of your pregnancy can increase the risk of fetal heart defects.
Drug, tobacco or alcohol use, or exposure to certain substances. Use of certain medications, tobacco, alcohol or drugs, such as cocaine, during pregnancy can harm the developing fetus.
Diabetes or lupus. Having diabetes or lupus might increase your risk of having a baby with a heart defect.
Minimally Invasive Surgery for ASD repair
When you go to the hospital, the nurses will give you a gown to change into, insert an IV in your arm so that you can have fluids and medications, and wheel you onto a stretcher to the operation room.
Perform Under general anaesthesia
The following procedures will be carried out during the surgery: Your chest will be fitted with electrodes for an EKG so that your heart may be continually monitored throughout the process. In order to access your heart, the surgeon will first place a small tube, known as a catheter, into a blood vessel in your arm or groin area.
To see your heart, he or she will perform an X-ray with dye injected. By inserting a tube, the surgeon will measure the hole's diameter.
The surgeon will check the size of the hole by inserting a tube containing a balloon inside the upper chamber of your heart. He/she will inflate the balloon to measure the size of the hole. Thereafter, the surgeon will send in another tube with a device to close the defect in your heart. Some devices open like an umbrella to cover the defect, while some cover the hole on both sides. After placing the appropriate device, the surgeon will remove the tube and place a bandage at the insertion site of the catheter.
At some institutions, a mini atrial septal defect repair is done as follows: The surgeon will make about a 3-inch incision on the right side of your chest. He/she will conduct a heart-lung bypass. In this procedure, the heart is stopped and blood circulation in the body is continued through a heart-lung machine.
The latter is connected to small tubes placed in an artery and vein in the right groin. Once you are attached to a heart-lung machine, the surgeon will open a space between your ribs using a soft retractor (a surgical tool used to hold back the underlying tissues). He/she will attach an ASD closure device to the catheter and insert it in the place at the defect. Once the device is fixed and the hole inside your heart is covered, the surgeon will disconnect the heart-lung bypass machine, remove the catheters and cover the site with bandages.
The surgery can take the surgeon one to two hours to finish.
You will spend two to four days in the hospital following the procedure.
Throughout the visit, the following will be looked after: In order to lessen your pain following surgery, you will be given medicines.
The nurse will apply pressure bandage or have you lie flat on your back in order to stop the bleeding from the incision site. It will be recommended that you consume enough of water to help your body rid itself of the color.
A chest X-ray, EKG, or blood test will be conducted to keep an eye on your heart and general health.
- Frequently Asked Questions About ASD Closure Surgery
- Q. How much does ASD Closure Surgery Cost in India?
A. The cost of ASD closure surgery ranges from $3500 – $5500 in India.
Q. What is the percutaneous closure device?
A. A percutaneous closure device is a specialized device used to treat patients with atrial septal defect and patent foramen ovale (PFO). In a catheterization procedure, this device is attached to the end of a catheter which is inserted through a vein in the leg and released at the site of the defect to close the hole.
Q. Is a PFO the same as an ASD?
A. Atrial Septal Defect and Patent Foramen Ovale are both birth defects in the septal tissue present between the left and right atria of the heart. ASD is a heart defect that one is born with due to the failure of formation of septal tissue between the atria while PFO only occurs after birth when the foramen ovale, a flap-like valve, fails to close.
An ASD hole is larger than that of a PFO and therefore, more likely to present symptoms.
Q. How does an atrial septal defect occur?
A. Congenital heart defects occur due to failure or errors in the development of heart during the foetal stage. Certain factors like gene defects, chromosome abnormalities and alcohol and drugs uptake by the mother during pregnancy can increase the risk of ASD in the baby.
Q. Can a hole in the heart cause a stroke?
A. Heart defects like ASD and PFO can possibly lead to a stroke. This can happen because the blood clot or a solid particle in the blood can move from the right side of the heart to the left side through the abnormal opening in the septal wall and then travel to the brain, causing a stroke.
Q. Is ASD life threatening?
A. A small atrial septal defect may never cause any problems because it often closes during infancy. The larger defects can cause a number of complications ranging from mild to life-threatening, including right-sided heart failure and stroke.
Q. Can atrial septal defect be inherited from family?
A. Congenital heart defects appear to run in families and sometimes occur with other genetic problems, such as Down syndrome.
Q. Can a patient live with ASD?
A. If the hole is small, the patient might not have any medical problems or it may even close on its own during childhood. The medium and large sized defects can have significant impact on the performance of the heart and lungs. This is because the oxygen-rich blood from the right atrium leaks into the left atrium with oxygen-poor blood and gets pumped back to the lungs, causing increased work-load for the heart.
The larger opening in the septa can cause serious complications and therefore, it must be closed surgically by an experienced cardiac surgeon. For a smaller ASD defect, cardiac catheterization is typically suggested as the primary treatment. But for a larger ASD defect, heart surgery is considered as the best possible option. Minimally invasive ASD heart surgery in India has a high success rate and is carried out by extensively trained and experienced doctors.