At a glance
Atrial Septal Defect (ASD) closure is a procedure that seals an abnormal hole in the wall separating the heart's two upper chambers, restoring the normal direction of blood flow. In a healthy heart, oxygen-rich blood and oxygen-poor blood are kept on separate sides of this wall, called the atrial septum. When a hole is present, blood leaks across, forcing the right side of the heart to work harder than it should.
The procedure can be done in one of two ways. Most patients today are treated with a minimally invasive catheter-based approach, where a thin flexible tube is guided through a vein to reach the heart and a small mesh device is then expanded to plug the hole. Patients whose anatomy is not suited to that approach have the hole closed through open-heart surgery instead.
Medical Condition
ASD closure is recommended when the hole is large enough to cause symptoms or strain on the heart, or when scans show the right side of the heart has already enlarged from the extra workload. Small defects that close on their own during childhood do not need this procedure, but those that persist into adulthood usually do.
- A confirmed ASD that is causing the right ventricle (lower-right chamber) to enlarge
- Shortness of breath, fatigue, or reduced exercise tolerance linked to the defect
- A stroke or TIA (mini-stroke) thought to be caused by a clot passing through the hole
- Paradoxical embolism, where a blood clot travels from the veins through the hole into the arterial circulation
- Pulmonary hypertension (high blood pressure in the lung arteries) at a stage where closure is still beneficial
- Children or adults where the defect has not closed naturally and imaging shows significant blood leakage across the wall
ASD closure is not suitable for every patient. Doctors will advise against it in certain situations.
- Severe, irreversible pulmonary hypertension (Eisenmenger syndrome), where closing the hole would actually worsen the patient's condition
- Very small defects with no symptoms and no sign of heart strain
- Active infection anywhere in the body at the time of the planned procedure
- Blood clots in the veins that have not yet been treated, in the case of the catheter approach
Risks & Complications
ASD closure is generally well-tolerated, but like any heart procedure it carries a set of recognised risks that your care team will discuss with you beforehand.
- Arrhythmia (irregular heartbeat), which may need medication or, occasionally, an additional procedure to correct
- Device-related complications: the closure device shifting position or, very rarely, eroding into surrounding heart tissue over time
- Residual leak: a small amount of blood continuing to pass around the device or patch
- Bleeding or bruising at the catheter entry site in the groin or neck
- Blood clot forming on the device in the weeks after placement, requiring blood-thinning medication
- Air embolism (air bubble entering the bloodstream) during the procedure
- Stroke or TIA caused by a clot dislodging during or shortly after the procedure
- Infection, including endocarditis (infection of the inner lining of the heart), which is rare but serious
- Allergic reaction to the contrast dye used during imaging guidance
- For open-heart surgery: risks related to the heart-lung bypass machine, including temporary confusion, kidney stress, and longer recovery
Preparation & Procedure
In the days before the procedure, patients are usually asked to stop blood-thinning medications and non-steroidal anti-inflammatory drugs under their doctor's guidance. Smoking slows healing and increases anaesthetic risk, so patients who smoke are advised to stop as early as possible before the date. Alcohol should be avoided for at least 24 hours beforehand.
Eating and drinking rules are strict. Most hospitals ask patients to stop eating solid food six hours before the procedure and to stop drinking clear fluids two hours before. This reduces the risk of complications from anaesthesia or sedation. Patients should confirm the exact fasting window with their hospital, as instructions can vary.
Several tests are usually ordered to plan the procedure and confirm the size and position of the hole. Common pre-procedure investigations include:
- Transoesophageal echocardiogram (TEE), an ultrasound probe passed into the throat to give a detailed image of the septum from behind the heart
- Transthoracic echocardiogram (TTE), a standard heart ultrasound through the chest wall
- Electrocardiogram (ECG/EKG) to check the heart's electrical activity
- Chest X-ray to look at the size of the heart and lungs
- Blood tests including full blood count, kidney function, and clotting studies
- CT scan of the heart in some centres, to map the exact anatomy before the procedure
On the day itself, the procedure follows an ordered sequence of steps, though the exact number and timing depend on the approach chosen.
- 1. The patient changes into a hospital gown and an intravenous (IV) line is placed in a vein in the arm for fluids and medications.
- 2. Monitoring leads are attached to the chest to track the heart's electrical activity throughout.
- 3. General anaesthesia or deep sedation is given so the patient is asleep and comfortable.
- 4. For the catheter approach: the groin area is cleaned and numbed, and a thin tube called a sheath is inserted into a large vein. The catheter is then threaded through the sheath up toward the heart.
- 5. A TEE probe or intracardiac echo (ICE) probe, a tiny ultrasound inside the heart, is used to guide the device to the correct position.
- 6. A guidewire crosses through the hole, and a folded mesh device is advanced over it and then expanded on both sides of the septum to plug the opening.
- 7. The doctor checks the device position with ultrasound and, if satisfactory, releases it and removes the catheter.
- 8. For open-heart surgery: the chest is opened, the patient is connected to a heart-lung bypass machine, the heart is stopped briefly, the hole is sewn closed or patched, and the heart is restarted before the chest is closed.
- 9. The patient is moved to a recovery or intensive care unit for monitoring.
Aftercare
After a catheter-based closure, most patients spend one night in hospital for heart monitoring and are discharged the following day if there are no concerns. Open-heart surgery requires a longer stay, typically several days, with part of that time in an intensive care setting. Recovery at home after the catheter approach is usually measured in days to a couple of weeks, while surgical recovery takes several weeks longer.
- Monitoring: heart rhythm is watched continuously for the first hours after the procedure; a follow-up echocardiogram (heart ultrasound) is usually done before discharge and again at one to three months to confirm the device is in position and the hole is sealed
- Blood thinners: patients who receive a catheter-based device are typically prescribed aspirin and sometimes an additional antiplatelet medication for three to six months while tissue grows over the device
- Activity: strenuous exercise, heavy lifting, and contact sports are restricted for a period your cardiologist will specify; most people can return to light daily activities within a week after catheter closure
- Wound care: the catheter entry site should be kept dry and clean; any swelling, redness, warmth, or discharge should be reported to a doctor promptly
- Dental and surgical procedures: patients with a closure device should inform every dentist or surgeon about it, as antibiotic cover may be recommended for a period
- Follow-up: cardiology appointments are usually scheduled at one month, three months, and twelve months, with further checks depending on the individual's progress
- Endocarditis (heart-lining infection) precautions: patients are generally advised to follow their cardiologist's guidance on this for the first six months after the device is placed
- Signs to watch for and report immediately: chest pain, palpitations (a racing or fluttering heartbeat), sudden shortness of breath, fainting, or any new neurological symptoms such as weakness on one side of the body or slurred speech
Cost & What Determines It
The total cost of ASD closure varies widely from country to country and from hospital to hospital, because so many factors feed into the final bill. The same physical procedure can carry a very different price depending on whether a device is used or the heart is opened surgically, the class of hospital, how complex the defect turns out to be, and what care is needed afterward.
- Defect size and complexity: a small, centrally located defect suited to catheter closure is technically simpler than a large or oddly shaped defect that requires open-heart surgery
- Approach chosen: catheter-based closure and open-heart surgical repair have different cost structures, with the latter involving longer anaesthesia time, an intensive care stay, and more nursing days
- The closure device itself: the mesh occluder used in catheter-based procedures is an imported medical implant, and its cost is usually listed separately from the procedure fee
- Hospital class and country: private cardiac centres in medical travel destinations price their services differently from government hospitals or community hospitals, and licensing costs, staff expertise, and facility overheads all feed into the rate
- Length of hospital stay: extra nights for observation, post-procedure complications, or mandatory recovery periods add directly to the bill
- Imaging and monitoring: TEE guidance during the procedure, post-procedure echocardiograms, and ECG monitoring may each be charged as separate line items
- Anaesthesia: general anaesthesia for a cardiac procedure is billed differently from lighter sedation and adds to the total
- Medications: antiplatelet drugs and, where needed, antibiotics after the procedure are usually an additional cost
- Pre-procedure investigations: blood tests, CT scans, and diagnostic echocardiograms done in the days before the procedure are often billed separately from the procedure itself
Hospital packages for ASD closure often bundle the procedure fee, one or two nights of inpatient care, basic nursing, standard medications, and an immediate post-procedure echo into a single quoted price. What tends to be charged separately includes the closure device, extended inpatient stays, follow-up outpatient appointments, and any imaging or specialist consultations needed before the main admission.
BPJS Kesehatan and most Indonesian private health insurance plans do not cover treatment received abroad, which means patients travelling overseas for ASD closure typically pay out of pocket or rely on a private international health insurance policy that explicitly covers overseas cardiac procedures. Before booking flights or committing to a hospital, requesting a detailed written cost estimate that lists each component separately is the most reliable way to understand the true total and avoid unexpected charges on discharge.
Frequently Asked Questions
How many sessions does ASD closure take?
ASD closure is done in a single procedure, not a course of sessions. Most cases are performed through a catheter (a thin tube guided through a blood vessel to the heart), so there is no open-chest surgery involved. A small number of patients need open-heart surgery instead, depending on the size and shape of the hole.
What does ASD closure feel like during and after the procedure?
During the procedure you will be under sedation or general anaesthesia, so you will not feel pain at the time. Afterwards, most people feel mild soreness or discomfort at the site where the catheter was inserted, usually in the groin. This settles within a few days for most patients.
How soon will I feel better after ASD closure?
Many patients notice an improvement in symptoms such as breathlessness and fatigue within weeks of the procedure, though the heart continues to adjust over several months. Your doctor will schedule follow-up checks, which may include an echocardiogram (an ultrasound scan of the heart), to track how well the closure device is settling. Full recovery and activity levels depend on your individual health and which technique was used.
How much does ASD closure cost?
The cost varies depending on whether a catheter-based or open-heart approach is used, the type of closure device implanted, the hospital class, and how long you stay. A catheter-based procedure typically involves a shorter hospital stay than open-heart surgery, which affects the total bill. Requesting a written estimate from the hospital is the most reliable way to get a figure that reflects your specific situation.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
