Q: Tell me about the condition you are treating where the patient has a hole in their heart?
Dr. Vincent: The hole in the heart that we are talking about is an atrial septal defect. There are four chambers in the heart, the atria are the two upper chambers, the ventricles are the two lower chambers. The tissue wall separating the chambers is called a septum and a hole in the wall is called a defect. Thus, a hole in the wall between the two atria is called an atrial septal defect or ASD.
Q: Does it happen when the child is born?
Dr. Vincent: All babies are born with a normal communication between their atria. It is necessary for normal fetal development. After birth the hole should close, and in some people it does not.
Q: What does that mean in terms of everyday life for these kids?
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Alternative to surgery
A new procedure closes the hole with a prosthetic patch.
 
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Dr. Vincent: Depending on the size of the hole and the impact on the heart, most kids are usually asymptomatic up until their teenage years. Some children may have symptoms earlier but most will not have any problems until their second or third decade if then.
Q: When you say symptoms, what kinds of things happen?
Dr. Vincent: They may develop fatigue, shortness of breath, abnormal heart beats (arrhythmias), heart failure or high blood pressure in the pulmonary arteries (pulmonary hypertension).
Q: What used to be the standard procedure for this kind of problem?
Dr. Vincent: The standard procedure was open-heart surgery. It is a very effective procedure. It was one of the first operations that was ever done to correct congenital heart defects. It is a very safe procedure and we still use it today when the defects are not appropriate for catheter closure.
Q: What does this new procedure allow you to do?
Dr. Vincent: It allows us to go in through the vein in the leg with a catheter and place the catheter across the hole in the heart. Then we can place a device through the catheter to close the hole. At that point, the device is released from the catheter and the catheter is removed. The patient is treated and the hole is closed without an open heart procedure.
Q: What does this mean for these kids?
Dr. Vincent: It means having this defect closed without an open-heart procedure.
Q: What would happen if your patient Anja had not had the hole in her heart fixed?
Dr. Vincent: If she had not had this procedure, she could have problems in the future. The problem is not everybody who has an atrial septal defect will develop symptoms at a given age, so you never know who is going to have problems, and how early it is going to occur. We close these defects in young children in order to protect their future, not to make them better than they are. Having said that, a number of parents come back to us and tell us that although they thought their children were perfectly normal beforehand, they are more active and have more energy after the procedure.
Q: In Anja's case, is this a preventive thing or is she going to have any trouble?
Dr. Vincent: She has been having a lot of headaches. Now there has been an association between atrial septal defects and what we call patent foramen ovale, (which is a very small hole) and migraine headaches. That is currently under study but that is not the reason we are specifically closing hers
Q: What kind of device do you use for the procedure?
Dr. Vincent: The HELEX™ device was developed by the W.L. Gore company. It is made up of a single nitinol wire frame, a variation of which is a circle, and around it is wrapped a layer of material called ePTFE, or expanded polytetrafluoroethylene, otherwise known as Gortex. It has been used in medical devices for a long time now. We are very comfortable with it. It has a great track record, and it is proven to be a very effective device for closing holes.
Q: Is Gortex the same material they use for waterproof tents and things like that?
Dr. Vincent: It is, or at least it is the same chemical structure. They make it many different ways. Some is made for commercial use on outside garments and outdoor wear and other ePTFE fabrics have been specifically designed for use in heart and vascular devices.
Q: And it works like a normal cloth?
Dr. Vincent: Yes. When the surgeons operate to close a hole in the heart, they will either use a direct suture technique (no material involved) or some synthetic material, such as Dacron or Gortex or natural material such as pericardium, the sac around the heart. Instead of using stitches to keep the patch in place, we have a metal framework that sits around both sides of the defect to keep the device in place.
Q: What's so exciting about this procedure?
Dr. Vincent: For anybody who has had the procedure, it's really awesome to be able to come in on the day of the procedure, have it done and go home either that day or the next day without any surgery or stitches. It's a tremendous advance that we have made over the last decade.
