Device closure of ASD

Device closure of ASD is suitable for secondum ASD with a good rim all around for holding the two discs together. Trans esophageal echo (TEE) is done to assess the superior, aortic and mitral rims as well as the total septal length. It is ideal to have TEE guidance during the procedure as well. A guide wire is introduced through the femoral vein into the inferior vena cava and furthur through the right atrium across the ASD. The tip of the wire is placed in the pulmonary vein and a long venous sheath is introduced. Once the sheath is in position, the device attached to the delivery cable is introduced into the sheath under water to avoid air bubbles in the system. Once the device reaches the left atrium, the left atrial disc of the device is released first and brought in contact with the left atrial side of the ASD. When the position is judged ideal, the right atrial disc is allowed to form by withdrawl of the sheath. Once the two discs are in position with the waist across the ASD, slight wiggling is done to make sure that the device is perfectly fitting and has no tendency for dislodgement. Position is confirmed by TEE with special care to see that the device does not interfere with the function of the AV valves. Once everything is fine, the device is released by unscrewing the delivery cable. The device usually used is the Amplatzer device.