Oct. 30, 2007

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Communications Department
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Heart procedure performed for the first time at Central Minnesota Heart Center

ST. CLOUD, Minn. – Cardiologist Jacob Dutcher, M.D., has performed the first catheter-based repair of an Atrial Septal Defect (ASD) ever done at the Central Minnesota Heart Center at St. Cloud Hospital.

Traditionally, the Central Minnesota Heart Center physicians have treated ASD and a similar condition (Patent Foramen Ovale, or PFO) with open heart surgery. This involved opening the chest cavity and sewing in a patch to close an abnormal hole between the upper chambers of the heart (left and right atria). Surgery was followed by a five- to seven-day hospitalization and months of recovery.

Now, with the minimally invasive procedure, patients are often discharged the following day and can return to full activity within a few days. The procedure itself usually requires less than an hour to perform and with much less risk and discomfort than open-heart surgery.

Dutcher himself was diagnosed with ASD when he was just 3 years old – and underwent successful open heart surgery at the age of 5. He has recovered fully and has lived a normal life since.

“My ASD greatly impacted my career path,” Dutcher said. “I believe my ASD was a blessing in disguise. It piqued my interest in medicine and instilled in me a great desire to care for people with similar conditions. I am very optimistic this new technique will revolutionize the way we treat people with heart defects.”

Normally, as a baby is developing in the mother, a small hole exists between the right and left atria (the top two chambers of the heart) allowing blood to bypass the lungs. Shortly after birth, when a baby takes its first breath, a small flap normally covers the hole redirecting blood to the lungs to obtain oxygen. A patient with an ASD either lacks the flap or has too small a flap to fully cover and seal the hole. As a result, there is an abnormal increase in blood flow in the right side of the heart, causing the right side to do more than its normal share of work. This may result in symptoms of fatigue and difficulty in breathing, such as the case of Dr. Dutcher. In severe forms (e.g. larger defects) heart failure and even death can occur at a young age. Fortunately, prompt recognition and closure of the hole can be curative and lead to normal life expectancy.

PFO is a heart condition similar to ASD except that the flap covering the hole is sufficient in size but fails to fully seal. As a result, blood intermittently is shunted from one side of the heart to the other. About 20 percent of all adults have a PFO. Fortunately, most people with a PFO never experience complications from it. However, in patients with an unexplained stroke or classic migraine headaches, as many as 50 percent of them have a PFO. Therefore, PFO may be a cause of migraine headache and stroke. The exact mechanism is unclear. It has been postulated that certain chemicals and small blood clots, which are normally filtered out by the lungs, could pass through the PFO, bypassing the lungs to reach the brain. This event could lead to stroke or migraine headache. Fortunately, most people with a PFO never experience signs or symptoms of stroke or migraine headache. However, those that do may benefit from this novel and minimally invasive closure of their PFO. Preliminary studies are underway to evaluate this hypothesis.

The new procedure requires two small tubes (about the size of a pencil) to be inserted through veins in the groin. This is done after the patient has received relaxing medications and a local numbing medication. Through one tube a small imaging probe is advanced into the heart for guidance in closing the defect. Through the other tube the device is advanced into the heart and deployed in the hole. The device, which is composed of opposing wings connected by a single stock, is much like two umbrellas connected together with their open ends facing each other. One wing is positioned on each side of the hole and they are “cinched” together to fully close the hole. The body grows new skin over the device and fully heals the area within a few months. The procedure is often completed in one hour with minimal risk and discomfort to the patient.

Learn more about the Central Minnesota Heart Center

Learn more about Dr. Dutcher

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