What’s New in Structural Heart Disease Treatment?

Structural heart disease may be congenital (present from birth), may occur as a result of an infection in the heart (endocarditis), from damage during a heart attack (post-infarction), or because of heart valve disease that progresses with age(most commonly aortic stenosis or mitral regurgitation).  Heart valve problems such as valve leaking(regurgitation) and valve stiffening(stenosis), if left untreated, can eventually lead to heart failure.  Similarly, defects(holes) in the septum (a wall of muscle separating the left side of the heart from the right side) can lead to heart failure if left untreated past childhood.  Fortunately, two new medical devices that can treat some of these very serious problems without conventional surgery have recently gained FDA approval!  The Amplatzer atrial septal closure device and the Sapien transcatheter valve have the potential to change the way physicians care for patients with atrial septal defect and aortic stenosis, forever.



Atrial Septal Defect and Structural Heart Disease Treatment

Photo Credit: Wikimedia.org

Atrial septal defect (ASD) is a hole between the top two chambers of the heart, the atria.  These defects are common structural heart disease conditions, and indeed, many children are born with atrial septal defects which eventually close on their own.  When the atrial septal defect does not close spontaneously, patients may develop heart failure symptoms (shortness of breath, trouble breathing with exercise) and even stroke.  The most common atrial septal defect in adulthood is called a patent foramen ovale (PFO).  Recently, physicians have gained considerable experience with a device that is designed to close the defect using a “plug” called a closure device.

By using the mesh closure device called the Amplatzer, cardiologists are now able to close the hole in a hospital procedure room known as the catheterization laboratory.  The Amplatzer, which is FDA approved, is a two-tiered, expanding device that closes the ASD.  The Amplatzer, is inserted through a catheter and placed securely in the hole. The clamshell-like device closes the hole and then stays in the heart.  While the patient receives general anesthesia, no large incision is needed. The closure can be performed as a short stay procedure, and the recovery time is just a few days. This type of treatment is much less traumatic and there is no incision or scarring.

Unfortunately, not every hole can be closed this way, and not every cardiologist is skilled in placing the device. Your cardiologists will conduct a thorough exam to make sure it’s the right treatment for you and refer you to a center that offers the service if appropriate.


The most effective treatment for aortic stenosis, a common heart condition that shows with chest pain (angina), loss of consciousness due to lack of blood flow (syncope), congestive heart failure, or sudden death, is valve replacement. However, large numbers of people are never referred for this surgery because they are deemed too high-risk even though the prognosis is grim without the treatment.  New technologies such as stent-based transcatheter valve replacement can now be performed on high-risk patients without the need for major surgery, a heart-lung bypass machine or stopping the heart.  This procedure will benefit the 4% of the general population over 65 years of that have severe aortic stenosis, and in the future could potentially treat lower risk patients such as in the 2% of the general population that have a defect called bicuspid aortic valves.

Transcatheter valve replacements should only be performed by an experienced, technologically adept team of cardiac surgeons, cardiologists and anesthesiologists.



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