Amplatzer Device Closure
You have already been told that you have a hole in your heart, known as an atrial septal defect (ASD). This hole needs to be closed. In the past the only way to close this hole was open heart surgery. Now it is possible to close an ASD with a device called an "Amplatzer device" by a procedure known as a "catheter technique". Some frequently asked questions about this catheter technique are listed below.
What is an Amplatzer device?
An Amplatzer is a device that works like a plug for the hole in your heart. It is made of a soft metal mesh alloy (known as Nitinol). This mesh looks like very tiny chicken wire fence. Inside the metal mesh is a thin layer of dacron, which is a soft cotton-like cloth. The Amplatzer device looks like two mushrooms joined at the stems. The device is very flexible and always goes back to the same shape even after being bent.
How does it get to my heart?
An Amplatzer is put into your heart by a "catheter technique". A catheter is a small, hollow plastic tube- similar to a drinking straw. The catheter can be inserted into a vein in your groin (the femoral vein) that is connected to your heart. The Amplatzer device is so flexible it can be pulled into the catheter. Then it can travel up the femoral vein in the catheter and into your heart. Once the device is in the right place in your heart it is "deployed" or pushed out of the tip of the catheter. When it is pushed out, it goes back to its double mushroom-like shape.
How does it fit in the hole?
The doctor will measure the size of the hole in your heart so that the right size of Amplatzer device is used. To measure the size of the hole in your heart the doctor will insert a balloon catheter through the opening in your femoral vein up to your heart. Then a balloon is put across the hole and blown up. The doctor then measures the size of the blown up balloon. This measurement will tell the doctor what size of Amplatzer device to use. The "stem" or middle part of the Amplatzer device is the part that fits into the hole. So a device that has a stem the same size as the blown up balloon will be used to plug the hole. When the Amplatzer device is pushed out of the catheter, one flat side will be on one side of the hole, the stem in the hole and the other flat side will be on the other side of the hole. The hole will then be plugged.
Can the device fall out?
No. If the device has been sized right, it will not be able to fall out. That is why the doctor measures the size of the hole and will double check that the device is in the right place before it is left in your heart.
What sizes are there?
Amplatzers come in a many different sizes. They can be used to close little holes, and big holes. The smallest Amplatzer is 4 mm and the biggest one is 40 mm.
Can my body reject the amplatzer device?
No. The Nitinol alloy is a nickel type product. It has been used for years in medical devices, such as pacemakers. The body does not try to reject it. Even if you are allergic to nickel, you can have this device put in. The allergy to nickel only happens on your skin, your heart is a muscle and so it does not react to the alloy.
How long does the catheter procedure take?
The catheter procedure takes 1-2 hours.
Am I awake for the procedure?
You are sleeping. When the doctor is putting in the Amplatzer device, a camera is put down your throat to help the doctor see the hole better and make sure that the device is in the right place and that the Amplatzer device fills the hole. Since you will have to lay on your back with a camera down your throat, it is easier if you are asleep. A general anaesthetic is used.
What happens to the Amplatzer device in my heart?
Over time a thin tissue layer grows ever the device. Your body begins by making a thin layer of blood clots over the mesh and dacron in the walls of the device. This begins a few minutes after the device is put in, and takes days to weeks to finish. The length of time it takes depends on how big the Amplatzer is. The device helps your body to have a framework to have the tissue grow over. It's like growing your own patch for the hole in your heart. Just like when you look at the back of your hand and can see the blue lines of blood vessels under your, the device will eventually look like that inside your heart.
Could I have too many clots form?
You are given a blood thinner through an intravenous in your arm during the procedure. The blood thinner will continue to infuse for about 8 hours after. For the next six months after the device is put in you will take one aspirin every day. This is so that you don't have too many clots forming on the Amplatzer device.
How long am I in hospital?
You are in hospital one day. Sometimes, you may even go home the same day. It depends on how late it is before the blood thinner in the intravenous is done.
What are the risks of having an Amplatzer device put in?
The risks are very low.
- The risks are the about 1 in 1000 that you will have problems with a clot (like a stroke or heart attack)
- Bleeding at the groin where the catheter was put in
- Injury to the nerves at the groin area
- Accidentally making another hole in the heart or the veins going up to the heart
- An allergy to the medication used
What are the advantages of using an Amplatzer device?
The biggest advantage is the recovery. Your recovery is faster much faster than if you had to have open-heart surgery. After open-heart surgery your recovery is six to eight weeks.
After an amplatzer device closure, you will need to take it easy for 48 hours. Don't do any heavy lifting (weights or heavy grocery bags) or straining (running, jumping, or vacuuming) for the first 48 hours. This is a precaution to give your groin site time to heal. Your heart itself does not have any limitations. After 48 hours you can return to work and begin getting back to your normal activities.
After an Amplatzer Device closure
After an Amplatzer device has been used to close the ASD in your heart there are some things that you should know.
Follow Up
You will see the cardiologist in 1 month.
The following tests will be done so the doctor can look at the Amplatzer device in your heart and make sure the hole is closed:
A chest x-ray
An ECG tracing
An echocardiogram
Antibiotic Prophylaxis
If you will be going to the dentist in the next 6 months after an Amplatzer device has been put in your heart, you will need to take antibiotics before you go. This is important for any dental work, especially regular teeth cleaning. If the ASD is your only heart defect, then after 6 months you will not need to continue doing this. The reason you need to do this is to decrease the risk of any bacteria from your mouth sticking to the Amplatzer device and causing an infection. After 6 months the Amplatzer is covered by tissue and this risk of infection is gone.
Heart Palpitations
Some people may have heart palpitations, where the can feel their heart racing or beating irregularly, because of their ASD. How often they have palpitations may increase for a few weeks after the hole is closed with the Amplatzer device. Others, who have never had palpitations before, may have them for the first time after the Amplatzer device is put in. These palpitations are not life threatening. They should go away over the next few weeks to months. The reason this may happen to some people is because of the catheter and the Amplatzer device touching the heart. Also, after having a procedure done to their heart, most people are more aware of their heart beating so they may notice little changes that they would not have noticed before.
Migraine Headaches
If you have migraine headaches, some people find that they have more migraine headaches for a few weeks after their ASD is closed. This does not happen to all people with migraines. If you have never had migraines before you will not start having them after. This increase in how often you get a migraine should stop over the next few weeks to months. The reason this may happen is not known.
Disclaimer
Reviewed by Alberta clinical experts. Brought to you by HealthLink Alberta. Copyright.
This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. For more health advice call Capital Health Link at 780-408-LINK (5465) 24 hours a day, seven days a week. In Alberta, call Toll-free: 1-866-408-LINK (5465)
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