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Device closure option for hole in the heart

“Your baby is born with a hole in her heart and will require early intervention to survive,” opined the paediatric cardiologist, browsing through the heaps of medical reports. As they felt the world around them come crashing, Anita and Bikram glanced helplessly at their 10-month-old daughter, gasping for breath.

They are not alone. Thousands of parents around the world suffer the same trauma when told their child is born with a heart defect. Statistics reveal that eight out of every 1,000 babies are born with one or more heart anomalies. A hole in the heart is one of the commonest congenital defects and can be classified into two categories.

“An atrial septal defect (ASD) is a hole in the wall separating the two atria (upper chambers of the heart), while a ventricular septal defect (VSD) is a hole in the wall between the two ventricles (lower chambers),” explains Biswajit Bandyopadhyay, consultant paediatric cardiologist, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS). Another common problem seen in babies is patent ductus arteriosus (PDA), an abnormal, persistent connection between the aorta and pulmonary artery that is supposed to close shortly after birth.

“These defects result in mixing of the oxygen-poor blue and oxygen-rich red blood, leading to severe damage of the spongy lungs, overloading and gradual failure of the heart and, eventually, a slow and painful death,” says Bandyopadhyay. Till a few years ago, open-heart surgery was the only treatment option for these children, where the sternum was split open, the heart stopped and repaired.

Now, another method is becoming an increasingly popular alternative — the device closure. Designed by Kurtz Amplatz of the US, the device looks like two discs joined together by a narrow waist. When placed over the hole, it prevents blood flow through the hole by forming a physical barrier.

Implantation is a cath lab procedure, where the patient is admitted the same day or a day before. The interventional cardiologist makes a tiny hole in the groin under local anaesthesia. After measuring the diameter of the hole accurately with balloons, the device is threaded through the catheter and manipulated over the defect. After making sure it is correctly positioned, the discs are released and pulled against the septum.

The device prevents shunting or abnormal movement of blood across the hole. It is made of Nitinol (an alloy of nickel and titanium) wire in such a way that it neither interferes with the contraction and relaxation of the heart, nor obstructs the normal flow of blood in any way. RTIICS, the super-speciality heart hospital off the Bypass, does device closures on a regular basis.

Being minimally invasive, device closure has a number of advantages over conventional open-heart repair, maintain interventional cardiologists. “Since there is no need to split open the chest, the pain and trauma associated with a major surgery is absent and there is no need for blood transfusion. Besides, hospital stay is reduced to 1-2 days, as opposed to the 8-9 days in an open surgery, thus nearly balancing out the cost of treatment,” explains Bandyopadhyay.

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