Transcatheter closure of an ASD or patent foramen ovale

The interatrial septum separates the two upper chambers (atria) of the heart. It may have an opening: an atrial septal defect (ASD), a true hole present from birth, or a patent foramen ovale (PFO), a small flap-like passage that did not fully close after birth and which is present in many people without consequence. Transcatheter closure involves bringing a device, folded inside a catheter, through a vein at the groin. It consists of two small wire-mesh discs that open on either side of the septum and sandwich it, like a press stud. Over time, heart tissue grows over the device. The procedure is guided by X-ray imaging and echocardiography (transoesophageal or intracardiac), under local anaesthesia with sedation or under general anaesthesia. An ASD is closed when it is large enough to overload and enlarge the right heart and its shape allows device closure. A PFO is closed only in specific situations, mainly after a stroke with no other cause found in a patient who is not too old, the decision being taken jointly by the neurologist and the cardiologist. Some ASDs with an unusual shape require surgery. At Clinique Pasteur Tunis, these closures are performed in a latest-generation catheterisation laboratory, supported by echocardiography and with a cardiac surgery team on site.