PINEHURST – Until a few months ago, FirstHealth of the Carolinas patients who needed minimally invasive treatment to correct two serious congenital heart defects would have had to seek their treatment at a large out-of-town medical center.

Both of those treatments are now available at FirstHealth Moore Regional Hospital.

Steven Filby, M.D., an interventional cardiologist with Pinehurst Medical Clinic and FirstHealth Moore Regional Hospital, recently performed the hospital’s first-ever non-surgical atrial septal defect closure as well as its first-ever non-surgical patent foramen ovale closure.

“Both patients are doing well,” says Dr. Filby, who was trained in the minimally invasive cardiac procedures at Ohio’s world-renowned Cleveland Clinic.

An atrial septal defect or ASD is a congenital (present at birth) heart defect in which the wall that separates the heart’s upper chambers (the atria) does not close completely. A small hole usually has little effect on heart function. With a large defect, however, large amounts of oxygen-rich blood can leak from the left side back to the right side – creating more work for the right side and symptoms that can include palpitations; shortness of breath, especially with exercise; and a susceptibility to pneumonia and bronchitis.

People with ASD are also at increased risk for developing atrial fibrillation, heart failure, pulmonary hypertension and stroke.

Dr. Filby’s patient, a woman in her 20s, was experiencing palpitations that had been controlled by medication for several years but then started again. An EKG revealed that the right side of her heart had become enlarged as a result.

During the procedure, Dr. Filby made tiny surgical cuts in the groin areas of both of the patient’s legs and then inserted a catheter in each leg – one with an intracardiac ECHO probe (a tiny camera that allows precise images of the heart) and the other with a wire mesh closure device. After conducting several tests to ensure the device was in the correct position, he released it into place.

Over time, according to Dr. Filby, the device will become coated with tissue and eventually become indistinguishable from the rest of the heart.

“The heart does a very good job of accepting this as a piece of tissue,” he says.

The second procedure, the patent foramen ovale closure, involved a man, also in his 20s, who had suffered a cryptogenic (hidden cause) stroke as a result of the defect.

The foramen ovale is a small hole in the atrial septum of the heart that is used to speed up the travel of oxygenated blood from the placenta through the umbilical cord to a fetus in the womb. In most cases, the hole will close naturally when a newborn takes its first breath. However, in 25 percent or more of the population, the foramen ovale does not close – causing a patent foramen ovale (PFO), a defect that works like a flap valve and opens under conditions when there is more-than-usual pressure inside the chest.

If the pressure is great enough, blood may travel from the right atrium to the left. If there is a clot in that blood, it can cross the PFO, enter the left atrium and travel out of the heart and to the brain (causing a stroke) or into a coronary artery (causing a heart attack).

According to Dr. Filby, people with PFO don’t need treatment if they don’t have associated problems. But, he says, closure is recommended to prevent recurrent problems in patients who have had a heart attack or stroke.

The procedure Dr. Filby used to close the PFO in his patient is very similar to the closure procedure for an ASD. Both involve catheters that are inserted into veins in the groins and then are advanced to the heart.

The only difference is a slight variation in the design of the two closure devices.

“Practically speaking,” Dr. Filby says, “it’s the same procedure.”

With both procedures, the patient is admitted to the hospital through the Outpatient Department, has the procedure while under conscious sedation and without a breathing tube, and then goes home the next day after several hours of bed rest

A typical PFO procedure takes about an hour to complete, while an ASD closure will take two to three hours. Physician follow-up is then prescribed for one month, three months, six months and annually.

A board certified cardiologist, Steven Filby, M.D., earned his medical degree at the Louisiana State University School of Medicine and completed additional training at Stanford University Hospital in California, the Cleveland Clinic in Ohio and UNC Hospitals in Chapel Hill.

Interested?

For more information on the defect closure procedures he performed at FirstHealth Moore Regional Hospital, call 715-1478 or (800) 213-3284.