First Percutaneous Atrial Septal Defect Closure at Doylestown Health

After suffering a stroke, a Doylestown Health interventional cardiologist corrects a young man’s heart defect, making a complete recovery possible.

The morning of March 9, 2020, started like any other. “Normal stuff,” recalls 40-year old Brandon Veneziale. His girls, ages 5 and 8 years old, were getting ready for school while his wife Kelly coordinated the morning activities. “I didn’t know anything was wrong,” recalls Brandon, until he saw the look on his wife’s face as he attempted to answer a simple question. “I thought that I was saying words,” remembers Brandon, although he describes “being stuck” as he tried to answer Kelly’s simple query. “I knew the answer but couldn’t get the words out,” says Brandon.

During Stroke, Time is Brain

Still unaware of the damage occurring in his brain, Brandon kissed his wife goodbye and prepared to get into his car and leave for work. Noticing that Brandon’s face was drooping, Kelly had the presence of mind to bring Brandon back inside and seek the help of a neighbor, who is a nurse, to assess his condition. They called 9-1-1 immediately when the nurse confirmed Kelly’s fears that Brandon was having a stroke.

Because he considered himself a healthy person, Brandon was unconvinced that he was suffering a medical emergency. He recollects initially resisting the ambulance ride, thinking his wife could take him to the hospital and wondering "what would the cost of the ambulance ride be."

As it turns out, not taking that ambulance ride could have cost him his life.

Stroke Care at Doylestown Health

Brandon remembers his condition worsening during the ambulance ride: eventually getting to the point where he could no longer spell his own last name—using numbers instead of letters—and then losing his ability to speak entirely. By the time he arrived at Doylestown Hospital, the stroke team was already waiting for him for an immediate assessment.

This is when he first met stroke coordinator Tammy Baker, whom Brandon credits as a significant player in his ultimate successful journey back to health. “I focused on her and saw the concern in her eyes,” he recalls, proclaiming Tammy’s care and attention to him “awesome.”

Brandon was quickly taken for tests, including a CAT scan, after which interventional cardiologist Steven Guidera, MD, FACC, FSCAI,confirmed the brain blood clot. Brandon was given a potent clot-busting medication called recombinant tissue plasminogen activator (tPA), which, in Brandon’s recollection, starting working quickly, allowing him to speak simple words and complete easy hand-eye tasks.

Heart Defect and Stroke

Once the initial emergency had passed, Brandon underwent a transesophageal echocardiogram (TEE). This special echocardiogram looks more closely at the heart. This was how Brandon discovered that he had a hole between the chambers of his heart. Known as an atrial septal defect (ASD), this hole in the wall (septum) between the two upper chambers of Brandon’s heart (atria) was present since birth.

Normally, the left side of the heart pumps blood to the body, and the right side of the heart pumps blood to the lungs. In someone with ASD, the pathway between the chambers allows free flow that can overwork the heart and lungs and eventually cause damage.

Dr. Guidera advised Brandon that an expert in ASD closure, interventional cardiologist James W. Hansen, DO, would soon be joining the heart and vascular team at Doylestown Health. Brandon decided to wait a short while to benefit from the surgical services of Dr. Hansen, whose skills Brandon calls “a miracle.”

Atrial Septal Defect

An atrial septal defect (ASD) allows blood from the left and right sides of the heart to mix and can keep the heart from working as it should, explains Dr. Hansen. In Brandon’s case, a small clot traveled from the right side to the left side of Brandon’s heart through the hole. The clot was then ejected through the arteries to the rest of his body (systemic circulation) and eventually to Brandon’s head, causing the stroke.

Dr. Hansen adds that because screening technology is presently so advanced, this defect is usually detected in childhood and rarely seen in an asymptomatic adult such as Brandon.

Percutaneous Atrial Septal Defect Closure

Because of Dr. Hansen’s advanced additional training, he had the expertise to perform the first percutaneous atrial septal defect closure ever at Doylestown Health (“Percutaneous” means that the surgery was performed via a catheter and not via open-heart surgery.) Dr. Hansen explains that this technique is done through the groin because the “veins big enough to accommodate the catheter are most easily accessed through the groin.”

Using equipment available in the cath lab and a transesophageal echocardiogram operated by another physician, Dr. Hansen crossed through the hole in Brandon’s heart with a wire, moving from the right atrium to the left, to deploy a device called an atrial septal occluder (ASO). Dr. Hansen compares an ASO to an “Oreo cookie.” One side of the “cookie” is positioned to sit at the hole in the septum, while the other “cookie” is pulled against it, thus closing the hole. The ASO device is permanent.

Prognosis is Excellent After ASD Closure

Dr. Hansen is thrilled to report that Brandon’s outcome is excellent and “no different than the general population.” After an initial six months of taking aspirin and Plavix, Brandon’s only reminder that he once had a heart defect will be the daily aspirin he will take for the rest of his life.

Brandon says that he was back to jogging within two weeks after surgery, and feels comfortable being back at his job involving significant physical labor. And while he feels that he’s “aged a little mentally” after the stroke experience, he’s back to the life he enjoys with his family and is grateful for the thorough and “miraculous” care that he received at Doylestown Health.