Transforming Cardiac Care: The Role of Atrial Septal Defect Closure Devices

Atrial septal defects (ASD) affect about 13 out of every 10,000 babies born in the United States each year (Centers for Disease Control and Prevention, 2024). This congenital heart condition, characterized by a hole in the septum between the two atria, allows oxygen-rich blood in the left atrium to mix with oxygen-poor blood in the right atrium. There are five types of ASDs: ostium secundum defect, ostium primum defect, sinus venosus defect, coronary sinus defect, and patent foramen ovale (some may contend that a PFO is not technically classified as an ASD). Over time, this abnormal communication can increase blood pressure in the lungs, enlarge the right side of the heart, increase the risk of a stroke, and, if untreated, lead to heart failure or pulmonary hypertension.

While ASDs smaller than 6 mm may close naturally, defects larger than 1 cm often require intervention (Behjati-Ardakani, 2016). Fortunately, advances in medicine have made it possible to effectively treat over 80% of ASD cases with minimally invasive catheter-based procedures, with a remarkable 93% success rate and faster recovery times when compared to traditional surgery (Cleveland Clinic, 2022). In this article, we’ll explore the essential role of cardiac sonographers in diagnosing, guiding, and providing long-term follow-up for ASD closure. The included 2D and 3D transesophageal echocardiogram (TEE) case examples illustrate the effectiveness and function of these devices.

A Brief History of ASD Closure

The closure of ASD’s has advanced significantly over the past century. Initially, open-heart surgery was the only treatment option, requiring surgeons to suture patches over the defect. While effective, this method carried high risks and involved lengthy recovery times. The development of percutaneous ASD closure began in the early 1970s when Drs. Terry King and Noel Mills performed the first animal trials on dogs in 1972, followed by the first human case in 1975. This pioneering effort demonstrated that closing atrial septal defects using a catheter-based approach was feasible. However, it wasn't until the 1990s that the technique truly gained traction, thanks to Dr. Kurt Amplatz, who developed the Amplatzer Septal Occluder, which became the first widely used device for percutaneous ASD closure. This marked a turning point in the management of ASDs, shifting from high-risk open-heart surgery to less invasive catheter-based procedures. Today, catheter-based ASD closures are the preferred treatment for most patients.