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Indications for closure and medical management of atrial septal defects in adults

Author
Heidi M Connolly, MD, FASE
Section Editor
Candice Silversides, MD, MS, FRCPC
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Atrial septal defect (ASD) is the most common congenital lesion in adults after bicuspid aortic valve. Although the defect is often asymptomatic until adulthood, potential complications of an undetected ASD include atrial arrhythmias, paradoxical embolization, cerebral abscess, right ventricular failure, and pulmonary hypertension that can become irreversible and lead to right-to-left shunting (Eisenmenger syndrome).

This topic will review indications for closure and medical management of ASDs in adults.

Surgical and percutaneous closure of ASDs, pathophysiology, anatomy, natural history, and clinical features of ASDs in adults, the identification and assessment of ASDs, and issues related to ASDs in children are discussed separately. (See "Surgical and percutaneous closure of atrial septal defects in adults" and "Clinical manifestations and diagnosis of atrial septal defects in adults" and "Identification and assessment of atrial septal defects in adults" and "Classification of atrial septal defects (ASDs), and clinical features and diagnosis of isolated ASDs in children" and "Management and outcome of isolated atrial septal defects in children".)

INDICATIONS FOR DEFECT CLOSURE

Overview — The main indication for atrial septal defect (ASD) closure is right ventricular enlargement with or without symptoms (eg, exercise intolerance, fatigue, dyspnea, heart failure, paradoxical emboli, arrhythmias) [1]. ASD closure is also reasonable in patients with paradoxical embolism or documented orthodeoxia-platypnea. Primum ASD closure is also indicated at the time of cleft mitral valve repair. (See "Clinical manifestations and diagnosis of atrial septal defects in adults" and "Management and outcome of atrioventricular (AV) canal defects", section on 'Surgical interventions'.)

Right ventricular volume overload — Closure (surgical or percutaneous) of an ASD is indicated in patients with associated right ventricular enlargement and no evidence of pulmonary arterial hypertension (pulmonary vascular resistance <5 Wood units) with or without symptoms [1-3]. (See "Identification and assessment of atrial septal defects in adults", section on 'Evaluation for RV overload'.)

                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Jan 22 00:00:00 GMT+00:00 2015.
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