Percutaneous Closure of ASD-VSD-PDA

Percutaneous closure seals a hole or abnormal channel in the heart with a plug delivered through a catheter, without opening the chest. The three usual targets are an atrial septal defect (ASD, a hole between the upper chambers), a ventricular septal defect (VSD, between the lower chambers) and a patent ductus arteriosus (PDA, a vessel between the aorta and lung artery that should have closed after birth).

Closing a significant defect stops extra blood flooding the lungs, prevents the right or left heart from enlarging and lowers the long-term risk of rhythm problems and lung pressure damage. Its main limit is anatomy: the hole needs firm rims and a safe distance from valves, so some defects still require surgery.

What Percutaneous Closure of ASD-VSD-PDA involves

A vein, and for VSD or PDA also an artery, is accessed at the groin. Pressures and oxygen levels are measured in each chamber to confirm how much blood crosses the defect and that lung pressures permit closure. For an ASD the hole is sized by transoesophageal or intracardiac echo, sometimes with a sizing balloon. A collapsed double-disc device made of nitinol mesh is pushed through a long sheath; one disc opens on the left side, the waist fills the hole and the second disc opens on the right. The operator tugs gently to test stability and checks nearby valves before unscrewing the cable. PDAs are closed from the lung artery or aortic side with a plug or coils. Tissue grows over the device within 3 to 6 months.

Who is a good candidate for Percutaneous Closure of ASD-VSD-PDA?

Closure is advised for defects large enough to enlarge the heart or, in selected cases, after a stroke thought to be related. Children and adults are both treated, in centres with congenital heart expertise.

• You have a secundum ASD with an enlarged right heart on echo and adequate tissue rims
• Your child has a PDA that is audible or is enlarging the left heart
• You have a muscular VSD, or a selected perimembranous VSD, with significant left-to-right flow
• Lung artery pressures and resistance are within limits that make closure safe
• You can take antiplatelet tablets for about 6 months

Es ist normalerweise nicht die richtige Wahl, wenn:

• You have a primum or sinus venosus ASD, which need surgery
• The defect is too large, has deficient rims or sits too close to a valve
• You have Eisenmenger syndrome, meaning lung pressures are so high that flow has reversed
• There is an active infection or a clot inside the heart
• The defect is tiny, causes no heart enlargement and only needs observation
• You have a nickel allergy severe enough to have caused systemic reactions, which needs discussion first

Technikoptionen

• ASD septal occluder: Self-centring double-disc device, such as the Amplatzer or a similar design. Standard for secundum ASD up to around 38 millimetres with good rims.
• PFO closure device: A related device for a patent foramen ovale after a cryptogenic stroke in selected patients under about 60.
• VSD occluder: Used for muscular and some perimembranous defects. Heart block is a specific concern near the membranous septum.
• PDA duct occluder or coils: Plugs for moderate and large ducts, coils for small ones; very high closure rates.
• Hybrid or surgical closure: For infants with large VSDs or unsuitable anatomy, surgery or a combined approach remains the standard.

Was passiert während Ihrer Behandlung

The procedure takes 1 to 2 hours. Children and adults needing a transoesophageal echo probe are given general anaesthesia; adults guided by intracardiac echo can have local anaesthetic and sedation. You will not feel the device opening. Afterwards you lie flat for 4 to 6 hours, have an echo and ECG the next morning and usually leave after 1 night.

Vorbereitung auf Ihre Reise

One session with 1 night in hospital. Allow 6 to 8 days in Istanbul for pre-procedure echo, the closure and a check echo before flying. Send your echo report, and ideally the images, beforehand so suitability can be judged. For a child, plan calmly, do not travel if the child is unwell with a fever, and arrange paediatric cardiology follow-up at home at 1, 6 and 12 months.

• Informieren Sie den Arzt über Medikamente, Allergien, Schwangerschaft oder Stillen und eine Vorgeschichte von Fieberbläschen, Keloidnarben oder Autoimmunerkrankungen
• Vermeiden Sie Alkohol, Aspirin und entzündungshemmende Schmerzmittel für ein paar Tage im Voraus, wenn Ihr eigener Arzt zustimmt, um Blutergüsse zu reduzieren
• Kommen Sie ohne Make-up auf dem Behandlungsbereich an und vermeiden Sie zwei Wochen vorher Sonnenliegen und starke Sonne

Genesung und Ergebnisse

Normal light activity resumes in 2 to 3 days. Avoid contact sports and heavy straining for about 4 weeks while the device beds in. Aspirin, sometimes with clopidogrel, is taken for around 6 months, and antibiotic cover before dental work is advised for the same period. Follow-up echoes check for any residual leak and device position.

• Back to everyday activity: 2 to 3 days; no contact sport for 4 weeks
• When results show: Heart size improves over 6 to 12 months
• Wie lange sie dauern: Dauerhaft

Sicherheit, Risiken und Revisionspolitik

Major complications occur in roughly 1 in 100 ASD and PDA closures and are somewhat more frequent with VSDs.

• Device moving out of position (embolisation), usually within 24 hours, needing catheter retrieval or surgery
• Atrial rhythm disturbances or palpitations in the first months
• Heart block, particularly after perimembranous VSD closure
• A small residual leak
• Clot forming on the device, or stroke
• Erosion of the device through the heart wall, which is very rare but serious
• Groin bleeding or vessel injury, more relevant in small children
• Headaches or migraine for some weeks after ASD closure

Jeder schriftliche Vorschlag wird durch Clinic-Y gibt an, was die Klinik abdeckt, wenn eine Korrektur erforderlich ist. Fragen Sie danach, bevor Sie buchen, nicht danach.

Cost of Percutaneous Closure of ASD-VSD-PDA in Türkiye

Clinic-Y does not publish a single price for Percutaneous Closure of ASD-VSD-PDA, because the honest figure depends on your case. What moves it:

• The device type and size
• General anaesthesia with transoesophageal echo versus sedation with intracardiac echo
• Adult or paediatric care, since children need a paediatric cath lab and anaesthetic team
• Diagnostic catheterisation or cardiac MRI beforehand
• Whether surgery turns out to be needed instead

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