In some children, an ASD may close on its own without treatment. With a small atrial septal defect, the rate of spontaneous closure may be as high as 80 percent in the first 18 months of life. An ASD still present by 3 years of age will probably never close on its own.
Although an atrial septal defect may be closed by open-heart surgery, this approach is not as common as it once was now that transcatheter closure devices are readily available. Should open heart surgery be deemed necessary, the surgeon may be able to directly close the hole with sutures or, depending on the size and shape of the hole, may need to close it with a patch. Surgery is very effective and carries a low risk profile.
Transcatheter Device Closure
Depending on the size and the area of the septum involved, many atrial septal defects may be closed by placement of a device during a cardiac catheterization. This device is inserted through a catheter and covers the ASD by attaching to the atrial septum. A catheter is a long thin tube, about the diameter of a piece of spaghetti, which is directed to the heart through the large blood vessels in the groin.
The benefits of being able to close an atrial septal defect with a transcatheter device is that it can be put in place without stopping the patient's heart or utilizing cardiopulmonary bypass, it doesn't have the psychological trauma related to open-heart surgery and it doesn't create a scarring across the chest the way open-heart surgery does.
Two FDA-approved devices are currently available in the United States and readily used in the catheterization laboratory. These include the Amplatzer Septal Occluder and the Helex Septal Occluder.
Atrial Septal Defect Closure Results
Surgical closure of atrial septal defects is complication free in more than 99 percent of cases. Although the Amplatzer device has only been utilized for a decade, its success rate also appears to be very high. After ASD closure in childhood, the heart size returns to normal over a period of four to six months.
Following closure of an atrial septal defect, there should be no problems with physical activity and no restrictions. Regular follow-up appointments will be made with a cardiologist; regardless of closure mode, mid-term and late problems can occur.