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Stories of the heart

International Heart Institute specialist’s plan repairs severe cardiac defect—without open heart surgery.

Greg Martin was born with a hole in his heart. Like most people born with an atrial septal defect (ASD), the most common congenitalMT_IHI_Heart Stories_ASDHeartDiagram heart disorder, he never knew he had it. But by the end of 2009, he knew something was wrong; at night, his heart palpitations were so strong that he couldn’t sleep.

Greg’s physician thought the palpitations might be caused by stress, but also heard a slight heart murmur and sent Greg for testing at St. Patrick Hospital’s International Heart Institute (IHI), where doctors found the ASD, a hole in the wall between the left and right chambers of the heart that allows blood to flow between them. By enabling oxygenated and oxygenated depleted blood to mix, an ASD can cause not only shortness of breath and palpitations but also pulmonary hypertension, heart failure and stroke.

An atrial septal defect allows blood to flow between the two chambers of the heart. Dr. Maddux says people with ASDs can have no symptoms for years, but it’s important to close the hole because patients who do so live about 10 years longer, based on research.

Most ASDs are in the 10-millimeter range— about the size of a marble—but Greg’s was the size of a golf ball. The hole in his septum was so severe there was really no separation between the atria at all, and he was scheduled for open heart surgery.

A Better Solution

ProvidencePhoto FrameIHIStoriesFromTheHeartfwIHI interventional cardiologist Tod Maddux, M.D., is one of only two cardiologists in Montana who specialize in a procedure that could fix the hole without the trauma of surgery. Known as “percutaneous closure,” it involves making an incision near the groin, then using a catheter to thread a patch up the femoral vein to the heart to cover the hole. It’s no ordinary patch: The fabric-lined expandable metal disc can cover the hole completely, and after six months, tissue will grow over the disc completely.

“Percutaneous closure is now the primary therapy for the majority of ASDs, and surgery is the alternative—even in severe cases like Greg’s,” says Dr. Maddux. Greg underwent the procedure in February 2010, awake except for a mild sedative, and was out of the hospital the next day. After a great checkup six months later, he has no palpitations, no heart problems and no need for future heart checkups. “To think that I live only four blocks from St. Pat’s, and at the time Dr. Maddux was the only person in the state who could do this, I felt very lucky,” he says.