Should I go for an ASD device?

[proseydas]

My daughter is now 15 month old weigning 9+ kgs, identified with ASD, VSD and PDA on her 2nd day. The VSD and PDA got closed by time. Unfortunately, the ASD started reducing, but increased again. 6 months back it was 9 mm, and now it is 14 mm by 20 mm. The doctor has suggested to go for an ASD device, as otherwise the whole may be touching the rims (body) and lead to open heart. She has no problem brest feeding, has never been out of breath, is active but tending to lie down while watching tv, gets cold most often. My questions are:
1.Is this the right time and age to go for the operation?
2. How painful is the operation? Will it need channels for saline feeding etc?
3. What are the chances that the body does not accept the foreign material, and lead to other symptoms?
4. Will there be any restriction afterwards?
5. Should I confirm through a second opinion from antoher cardio?
6. What are the options and precautions in case the device did not work?

[Jeffrey R Boris, M.D.]

Dear Proseydas,

Transcatheter placement of an atrial septal defect occluder device in experienced hands has replaced surgical closure of secundum ASDs, by and large.  Usually, these children have this done around ages 3 to 5 years.  The device is placed through a catheter into the defect while the child is under anesthesia; there is no associated pain and, although an IV is placed, these children do not need prolonged hydration or feeding separate from what they take in by mouth.  Afterward, they awaken and typically stay overnight to ensure that there are no complications.  These children tolerate the procedure well and have no restrictions, though they usually are placed on a low dose of aspirin for the first six months after the procedure to prevent blood clots from forming on the device while the lining of the heart grows into and covers over the device.  There are extremely rare cases of allergy to the material in the device, but overall, it does not cause problems.

Placement of the occluder device depends upon having a defect that has an adequate rim of tissue surrounding it that the device can grasp.  if there is not adequate rim, or if there is some other reason that the device can't be used, surgical closure of the defect can always be done.  I would make sure that you go to a place that has extensive experience with this to ensuer the optimal decision making and outcomes.

[proseydas]

Dear Doctor,
Thank you very much for your much needed answers. Your guidance will surely help us take the decision.
Regards,
Prosenjit.