16838 Cardiac Implant Closure Devices In Adults

Overview

A cardiac implant closure device is a small implant placed inside the heart to seal an abnormal opening or leak. It is often shaped like a small disc, plug, or mesh patch. It is usually put in through a thin tube called a catheter, which is passed through a blood vessel in the groin, so open heart surgery is not always needed. Over weeks to months, the body's own tissue grows over the device to help seal the area.

Closure devices are routinely used in specialist heart centres. Some heart openings, such as a patent foramen ovale (a small flap-like opening between the upper heart chambers that did not fully seal after birth), are common in adults, but most never need a device. Whether closure is right for you depends on the specific problem, your symptoms, and your overall health.

This usually affects adults with a heart opening present from birth, a persistent opening linked to stroke, a leak around a heart valve or patch, or certain heart rhythm problems where closing a small pouch in the heart called the left atrial appendage is considered. Some people are diagnosed only in adulthood. Children with similar heart problems are cared for by paediatric heart teams.

Symptoms

Common symptoms

• No symptoms at all — the opening may be found during tests done for another reason.
• Breathlessness, especially when active or lying flat.
• Tiredness or low energy.
• A feeling of a fast, pounding, or irregular heartbeat.
• Swelling in the legs, ankles, or abdomen.
• A bluish tint to the lips or skin in some types of heart opening.
• Recurrent unexplained stroke or transient ischaemic attack (TIA, a mini-stroke), especially with a patent foramen ovale.

Symptoms in children

• This article is about adults. Children with similar heart openings are looked after by paediatric heart teams.
• Poor feeding or slow weight gain.
• Fast breathing or working hard to breathe.
• Tiredness during play or feeding.
• Frequent chest infections in some children.

Symptoms in older adults

• More noticeable breathlessness and tiredness with everyday activity.
• Leg swelling or ankle swelling.
• Irregular heartbeat, such as atrial fibrillation (an irregular heart rhythm).
• A higher chance of having other heart or lung conditions that need checking.
• Symptoms may come on more slowly and be put down to ageing, so tests are important.

Causes

Main causes

• Being born with a hole between heart chambers, called a congenital heart defect.
• A patent foramen ovale (PFO), a small flap-like opening between the upper heart chambers that remains after birth.
• A leak around a replacement heart valve or a patch, called a paravalvular leak.
• A leftover opening after heart surgery.
• In some people with atrial fibrillation, a device closes the left atrial appendage, a small pouch in the heart, to lower stroke risk when anti-clotting medicines are not suitable.

Risk factors

• Being born with a heart defect or having a family history of congenital heart disease.
• Previous heart surgery or valve replacement.
• Atrial fibrillation, an irregular heart rhythm.
• Previous stroke or transient ischaemic attack (TIA, a mini-stroke).
• Older age and other heart or lung conditions.
• High blood pressure or smoking, which can add to heart strain.

When to see a doctor

See a doctor urgently if:

• If you have a closure device and develop fever, wound problems, new breathlessness, palpitations, or chest pain, seek urgent medical advice.
• If you have symptoms of stroke or severe breathing difficulty, call your local emergency number immediately.
• If you notice bleeding, fast swelling, or severe pain at the catheter site, get urgent help.

Book a routine appointment if:

• Attend follow-up appointments and imaging tests after device placement.
• Tell your dentist and other doctors that you have a heart implant before dental or other procedures.
• See your doctor if your symptoms change gradually, such as increasing tiredness or breathlessness.
• Ask your doctor about family screening if you have a family history of congenital heart disease.

Diagnosis

A cardiologist (heart specialist) will ask about your symptoms, past health, and family history, examine you, and arrange imaging. The tests show the size, position, and effect of the opening or leak. The team also checks whether closure is likely to help you and whether other treatments may be safer.

Tests that may be done

• Echocardiogram — an ultrasound scan of the heart using sound waves.
• Transoesophageal echocardiogram — a scan using a small probe passed into the food pipe after sedation, which gives clearer pictures of some heart openings.
• Bubble study — a test using tiny bubbles in a vein to check for abnormal blood flow across a heart opening.
• Cardiac catheterisation — a procedure using a thin tube to measure pressures and take pictures inside the heart.
• CT or MRI scan of the heart to plan a procedure or check nearby structures.
• ECG or Holter monitor to check the heart rhythm.
• Blood tests to check general health and rule out other causes.

What to expect at your appointment

Many tests are painless. An echocardiogram uses a probe on the chest. A transoesophageal echo uses sedation, so you may be asked not to eat or drink beforehand. A cardiac catheterisation uses local anaesthetic and a thin tube. The team will explain the results and your options in plain language.

Treatment

Treatment is tailored to you. Not every opening needs closure. The heart team weighs the benefits of closing the opening against the risks of the procedure and your other health conditions. A closure device may be recommended to reduce symptoms, lower stroke risk, or prevent heart strain. The device is usually placed in a catheter laboratory through a vein or artery in the groin. Some people go home the same day; others stay overnight.

Self-care at home

• Follow your discharge instructions exactly, including activity limits and wound care.
• Keep the catheter site clean and dry, and check for bleeding, swelling, or infection.
• Take medicines exactly as prescribed, and do not stop or change them without asking your clinician.
• Carry your device card and tell dentists, doctors, and airport security staff if needed.
• Attend follow-up echocardiograms and clinic visits.
• Avoid heavy lifting or strenuous exercise for the time advised by your team.

Medical treatments

Doctors may use medicines to ease symptoms, control heart rhythm, lower blood pressure, or reduce the chance of blood clots. The choice depends on your condition. Medicines are not a way to close the hole itself; they support heart health or lower risk. Your clinician will explain the benefits and possible side effects and review your medicines regularly.

When is surgery considered?

Open heart surgery may be considered if the opening is very large, the shape or position is not suitable for a catheter device, or if there is a complication. This is decided by a specialist team. Surgery is not needed for most people who are suitable for a closure device.

Living with this condition

Most people return to normal activities after recovery. You may feel tired for a few days. Follow your team's advice about driving, work, lifting, and exercise. Keep taking medicines and go to follow-up visits. Tell your dentist and other doctors that you have a heart implant. Call your team if you notice new symptoms.

Lifestyle tips

• Do not smoke; ask for help to quit.
• Eat a heart-healthy diet with plenty of vegetables, fruit, whole grains, beans, nuts, and fish; limit salt and processed foods.
• Be active as advised; walking is often a good start.
• Keep a healthy weight and manage blood pressure and blood sugar.
• Get enough sleep and manage stress.
• Limit alcohol and avoid recreational drugs.

Diet and exercise

A heart-healthy eating pattern and regular gentle activity help your heart and general health. After a closure procedure, start exercise slowly and follow your team's plan. Ask about cardiac rehabilitation if you have had heart problems. Avoid very strenuous activity until your doctor says it is safe.

Mental health and emotional wellbeing

It is common to feel worried before or after a heart procedure. You may worry about the device, stroke risk, or returning to normal life. These feelings often ease with time and support. If you feel very anxious, low, or unable to cope, tell your GP or heart team. If you have thoughts of harming yourself, contact your local emergency number or a crisis service right away.

Prevention

Most openings that need closure are present from birth or result from heart surgery or valve disease, so they cannot usually be prevented. You can lower your overall heart risk by not smoking, managing blood pressure, staying active, and eating well. After a device is placed, follow-up and reporting symptoms help prevent complications.

Vaccines

Keep routine vaccinations up to date. Ask your clinician whether any extra vaccines are recommended for you, especially if you have heart disease or are due for a procedure.

Screening programmes

If you have a family history of congenital heart disease, ask your doctor whether family screening is appropriate. After a closure device, regular imaging and clinic checks are monitoring rather than screening.

Complications

If left untreated

• If a hole or leak that needs treatment is left alone, it can sometimes lead to stroke or transient ischaemic attack (TIA), because a clot can pass through the opening.
• Heart strain or heart failure, with breathlessness, tiredness, and swelling.
• Irregular heart rhythms.
• High blood pressure in the lungs, called pulmonary hypertension.
• Worsening leak around a valve or patch.
• For people with a device, missing follow-up can mean device movement, clot, infection, or a remaining leak is not found early.

Long-term outlook

Most adults who are suitable for a closure device do well. The procedure can reduce symptoms and lower the risk of complications for selected people. Not everyone needs closure, and the benefits must be balanced against procedure risks. With follow-up and a heart-healthy lifestyle, many people return to normal activities. Your heart team can give you the most accurate outlook for your situation.

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