In case of sudden chest pain, shortness of breath or fainting, call 112.
Closing a hole in the heart (ASD)
A hole present from birth in the wall between the atria (ASD) can, in suitable patients, be closed with a small two-disc device passed through the vein in the groin. The chest is not opened.
What is it?
The atria, the two upper chambers of the heart, are separated by a thin wall. A hole in this wall that is present from birth is called an atrial septal defect (ASD). It may cause no symptoms for many years and is sometimes found in adulthood, during a check-up or an echocardiogram done for another reason. Blood usually flows through the hole from the left side to the right. Over the years this extra blood can strain the right side of the heart and the blood vessels of the lungs. Breathlessness, tiredness and palpitations may develop. When the hole is suitable, it can be closed without opening the chest, using a device placed by catheter. Device closure is usually chosen for the most common type, "secundum" ASD, when the edges of the hole are suitable to hold the device. Other types may need surgery. Prof. Dr. Barış Kılıçaslan's work includes the minimally invasive, catheter-based treatment of structural heart disease.
Who is it for?
- Patients with a secundum ASD whose right heart shows strain from the blood passing through the hole
- Patients with symptoms such as breathlessness, tiredness or palpitations; closure may be advised even without symptoms if the right heart is under strain
- Patients whose hole has a size and edges suitable for device closure
- Closure may not be suitable if the pressure in the lung blood vessels is severely raised; the decision is made by your doctor and the heart team after a detailed assessment
Before the procedure
Before the procedure, transoesophageal echocardiography (TOE), an ultrasound scan taken from inside the food pipe using a thin probe passed through the mouth, is used to examine the type, size and edges of the hole in detail. This shows whether the edges are strong enough to hold the device. If echocardiography suggests that the pressure in the lung blood vessels may be high, this pressure is measured directly with a catheter before closure. Your medications are reviewed with your doctor before the procedure. Do not stop any medication on your own. You will be asked not to eat or drink for a period before the procedure.
How is it done?
- Anaesthesia and imaging: The procedure is usually done under general anaesthesia or sedation. The heart is watched with ultrasound methods such as TOE.
- Access: A thin sheath is placed in the vein in the groin. The catheter is advanced to the right atrium and then through the hole into the left atrium.
- Measuring the hole: The size of the hole is measured with imaging, and if needed with a thin balloon, and the device size is chosen.
- Opening the device: The folded two-disc device is opened, first the disc on the left atrial side and then the disc on the right side. The two discs close the hole from both sides.
- Check and closure: The position of the device and whether blood has stopped passing through the hole are checked with echocardiography. If all is well the device is released, the catheter is removed and the access site is closed.
Recovery
After the procedure you are closely monitored for a while. Short bed rest is advised to protect the access site in the groin. Before discharge, the position of the device is checked with echocardiography. Over time, the heart's own tissue grows over the device. During this period you take antiplatelet (anti-clotting) medicine for a while so that no clot forms on the device; your doctor decides which medicine and for how long. Echocardiography check-ups are done at set intervals. In some cases, preventive antibiotics may be advised before dental treatment and similar procedures in the period after the device is placed; your doctor will decide. After discharge, call 112 if you have growing swelling or bleeding at the access site, sudden breathlessness or chest pain, difficulty speaking, or sudden weakness in an arm or leg.
Risks
Like every interventional procedure, this procedure has risks. The main ones are bleeding or bruising at the access site, heart rhythm disturbances, the device moving out of place (in which case it can be removed by catheter or surgery), a clot forming on the device, and stroke. Very rarely, fluid can collect around the heart or the device can damage the heart wall. Your doctor will explain the possible benefits and risks for you in detail, based on your personal situation, before the procedure.
Frequently asked questions
- Why was the hole only found in adulthood? An ASD may cause no symptoms for many years. For this reason it is often found in adulthood, during a check-up or an echocardiogram done for another reason.
- Can every ASD be closed with a device? No. Device closure is usually used for secundum ASDs with suitable edges. Other types, or holes that are not suitable for a device, may need surgical closure.
- Does a small hole always need to be closed? Not always. Small holes that do not strain the right side of the heart can be followed with regular check-ups without closure. The decision is based on the echocardiography findings.
- Does the device stay in my heart permanently? Yes, the device is permanent. Over time, the heart's own tissue grows over it.
- When can I return to daily life? Most patients return to their daily activities quickly. You will be given specific advice on strenuous exercise and heavy lifting when you are discharged.
Medical content reviewed and approved by Prof. Dr. Barış Kılıçaslan. Last updated: 4 October 2026. Editor: Baran Zeydan (info@clinixcrm.app).