Fixing a Hole in the Heart

Minimally invasive procedure reduces risk of stroke

Harsha Nagarajarao, M.D.

Harsha Nagarajarao, M.D.

For patients who need treatment for a birth defect that causes a hole in the heart, there is a safe — and much less costly — alternative to open-heart surgery.

The procedure to close the hole (known as an atrial septal defect, or ASD; and a smaller defect which causes stroke, called Patent Foramen Ovale, or PFO) takes a much different route. Doctors open a vein/vessel near the groin and insert a long, thin tube called a catheter. The catheter, loaded with a device called an Amplatzer septal occluder, is guided into the interior of the heart. Once in place, the device is released. Made of a springy alloy, it expands into a circular coil, closing the hole.

Texas Tech Physicians of El Paso interventional cardiologists are performing this minimally invasive cardiac catheterization procedure, known as a transcatheter coil occlusion, at University Medical Center of El Paso. Over the past several months, TTP El Paso doctors have performed ten coil occlusion procedures at UMC. TTP El Paso is the clinical practice of Texas Tech University Health Sciences Center El Paso.

TTP EL Paso interventional cardiologist Harsha Nagarajarao, M.D., center, performs a minimally invasive cardiac catheterization prodcedure at University Medical Center of El Paso.

TTP EL Paso interventional cardiologist Harsha Nagarajarao, M.D., center, performs a minimally invasive cardiac catheterization prodcedure at University Medical Center of El Paso.

About 15 years ago, almost 90 percent of ASDs were repaired through open-heart surgery, said TTP El Paso interventional cardiologist Harsha Nagarajarao, M.D., who serves as co-director of the Cardiovascular Catheterization Laboratory at UMC. Today, the minimally invasive coil occlusion procedure is widely used across the world to treat congenital heart holes.

The catheter, loaded with a device called an Amplatzer septal occluder, is guided into the interior of the heart.

The catheter, loaded with a device called an Amplatzer septal occluder, is guided into the interior of the heart.

Earlier this year, a 36-year-old man who suffered multiple strokes over two years with no indication of a cause was referred by TTP El Paso’s neurology department to Dr. Nagarajarao’s cardiology team. The doctors determined he had a PFO which was responsible for his stroke and scheduled him for the coil occlusion procedure.

The surgery, performed by Dr. Nagarajarao, was a success and significantly reduced the risk of stroke for the young person. The surgery took about two hours and required only light anesthesia.

Up to 25 percent of people are born with this kind of hole. Not all of them will require surgery, but those that present with stroke will need to have the hole closed, Dr. Nagarajarao said.

A display model of an Amplatzer septal occluder and a catheter tube.

A display model of an Amplatzer septal occluder and a catheter tube.

Dr. Nagarajarao, who also serves as an assistant professor in the division of cardiology at TTUHSC El Paso, adds that there is a large, unmet need in the El Paso area for treating ASDs and PFOs. To help increase the numbers of physicians capable of treating ASDs, Dr. Nagarajarao is helping train TTP El Paso physicians for certification in the procedure. Several of them joined him in assisting with the surgery on the 36-year-old.