Cardiologist Uses Latest Technology to Close Holes in Hearts

People from across the state are being referred for the new procedure

May 17, 2002

A local cardiologist is among a handful in the state using a new product to repair holes between the chambers of the heart in both children and adults. The new method doesn't involve traditional surgery, leave a scar, or require an extended hospital stay.

Daniel Miga, M.D., director of pediatric interventional cardiology at Golisano Children's Hospital at Strong, is one of only two doctors in Upstate New York offering the procedure. Miga works in the catheterization lab, diagnosing and treating people who have congenital heart problems. The process of cardiac catheterization involves advancing a catheter into the heart through blood vessels to obtain blood samples, take detailed pictures, and detect and correct congenital abnormalities of the heart.

Using a device called the Amplatzer Septal Occluder, Miga can close an atrial septal defect - a hole located between the left and right atria in the heart - without resorting to surgery. These are one of the most common congenital heart defects, accounting for 6 percent to 10 percent of all heart defects. The Occluder is a self-expandable wire mesh device, with polyester fabric to help close the defect. "These devices make a huge difference for patients," Miga says. "It's safe, effective, and can eliminate the need for surgery and a large incision in the chest."

Under normal circumstances, there is no communication between the chambers of the heart. An atrial septal defect is a hole between the left and right atrium, which causes an increase in blood flow to the right side of the heart. Because it is receiving so much extra blood, the right side of the heart does more than its share of work. This may cause the patient to feel tired, have difficulty breathing, stunt normal growth, or experience more respiratory infections. Sometimes these symptoms are seen in children, but often aren't noticed until adulthood. Larger defects can lead to heart failure and death.

To implant the Amplatzer Septal Occluder, a patient is generally sedated under anesthesia. After the patient - a child or adult - is asleep, a tube will be inserted in a vein in the groin. The next step is to insert a small tube, called a catheter, into the groin, and then navigate the catheter through the body's largest veins until it reaches the heart. After further testing including ultrasound imaging, a catheter is used to insert the device, which springs open around the hole in the heart. It builds a new wall where the opening was and, for the next several months, the heart tissue grows around it to fortify it.

The device is made of heat-treated nickel-titanium wires, and has super elastic properties. It can be compressed into a small tube for delivery. When it is releases from the end of the catheterization tube, it springs open, returning to its original shape. As the device expands outward, it repairs the defect.

Even for the healthiest patients, Miga says open-heart surgery means spending several days in the hospital, enduring a significant amount of pain, and a recovery period that lasts for weeks. That's not the case with the Amplatzer Septal Occluder, which was approved last fall by the Food and Drug Administration. The procedure takes about two hours and most patients go home the morning with only a few restrictions.

For more information about the Amplatzer Septal Occluder, call 585-273-2160.

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