An ASD is a hole in the wall (the septum) which separates the top two chambers of the heart. This malformation occurs in the developing fetal heart, long before birth, and is present in approximately 4/100,000 newborns. Most children with ASD have no symptoms at all. The defect may get discovered when a heart murmur (an extra cardiac sound) is discovered. The defect is then diagnosed using echocardiography (a cardiac sonogram). Interestingly, as people age, adults may begin to develop symptoms with an ASD. Most commonly, an ASD is discovered in an adult when the patient complains of heart palpitations or exercise intolerance or has a stroke. The majority of ASD can now be repaired with a catheterization procedure, and no longer requires open heart surgery.

Catheterization Treatment
In this well established procedure, which dates back to the late 1980's, a special self-expanding patch, resembling two small umbrellas connected to one another, is implanted into the defect of the wall through a small tube (catheter), advanced from the vein in the leg. With novacaine given in the leg, and some sedation given through an intravenous, a needle hole is made in the femoral vein, and a thin tube passed through the needle hole, up the vein, and into the heart. The procedure is guided by both x-ray and sonogram imaging. The tube is then passed through the hole to the left side of the heart, and the umbrella device, collapsed into the catheter, and pushed up to the heart. The first umbrella is opened in the left side of the heart, and is pulled back against the wall, covering the hole. Since the umbrella is substantially larger than the hole, it will not be able to pull back to the right side. With the first umbrella firmly against the left side of the wall, the second umbrella is opened on the right side of the wall, covering the other side of the hole. The second umbrella is also too large to fit back through the hole, fixing the device in place, like a molly bolt used to hang a picture. The device is then released. The procedure takes approximately 40 minutes, involves no pain at the leg or in the chest, and, as a result, can be done with the patient awake.

Coarctation of the Aorta is a birth defect of the major cardiac artery (aorta) which carries the blood from the heart, to every other part of the body to supply oxygen and other nutrients. A narrowing of the vessel, in the upper chest, creates an obstruction to flow which results in high blood pressure in the arms and head, with low or normal blood pressure in the legs. It also places a significant strain on the pump of the heart (left ventricle). High blood pressure, related to coarctation, can result in many of the usual problems seen with high blood pressure from other causes including stroke and premature coronary artery disease, but rarely may result in leg cramping with exertion, kidney dysfunction or even tearing/rupturing of the vessel wall. Coarctation can be repaired in many cases without surgery, during a catheterization procedure.

Catheterization Treatment
As an alternative to surgical repair, some people with coarctation of the aorta may be candidates for a cardiac catheterization procedure which involves passing a balloon and a device called a stent, into the area of the narrowing ,which can be inflated to expand the narrowed area and keep it open. With sedation through an intravenous line, and novacaine given to numb the leg, a needle is introduced into the femoral artery (in the leg). A small tube (a catheter) is advanced to the area of the coarctation, where a picture (angiogram) is taken to define the anatomy. Based on the size of the narrowing, a new catheter with a balloon built into its tip is prepared by placing the metallic stent over the balloon. The balloon catheter and stent are then advanced to the coarctation site. The balloon is then inflated with low pressure, expanding the stent against the aortic wall, and enlarging the narrow portion to the desired size. When the balloon is deflated, the stent maintains its shape, snug against the aortic wall, and keeps the vessel from narrowing back down. All of the tubes are then removed. The procedure takes approximately one hour.

A PFO is similar to an atrial septal defect (see above). It is a flap-like communication in the dividing wall, which allows abnormal flow between the upper two chambers of the heart. Unlike an atrial septal defect, every baby is born with this flap which is a critical part of the fetal circulation. In ~80% of all people, the two pieces of the flap fuse completely together forming a solid wall after birth . When the flap fails to fuse completely, in one out of five people, a pathway remains, that allows ongoing blood flow from the right side of the heart to the left. In a small number of these patients, the persistence of the flap has been associated with stroke, TIA, migraine headaches, the "bends" in divers, and low oxygen levels in rare patients. When patients do have symptoms, PFO can always be repaired without open heart surgery.

Catheterization Treatment
A double umbrella device can be passed to the heart through a small tube introduced at the leg, just as with repair of the atrial septal defect (above). The procedure takes less than 30 minutes to complete, is performed with the patient lightly sedated, and may require a one night hospital stay. The patient will be walking in 4 hours, and may participate in full exercise within 5 days.