Management and outcome of isolated atrial septal defects in children
- G Wesley Vick, III, MD
G Wesley Vick, III, MD
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Louis I Bezold, MD
Louis I Bezold, MD
- Professor of Pediatrics
- The Ohio State University
- Director of Cardiology Consultation Service
- Nationwide Children's Hospital
Congenital defects of the atrial septum are common, accounting for approximately 7 percent of congenital heart disorders . They can occur in several different anatomic portions of the atrial septum, and the location of the defect generally reflects the abnormality of embryogenesis that led to the anomaly (figure 1). An atrial septal defect (ASD) can be isolated or can be associated with other congenital cardiac abnormalities. The sizes of ASDs are variable, and their functional consequences are related to the anatomic location of the defect, its size, the presence or absence of other cardiac anomalies, as well as systolic and diastolic function of the ventricles.
The management and outcomes of children with an isolated ASD will be reviewed here. The classification of ASDs, and the pathophysiology, clinical features, and diagnosis of isolated ASD in children are discussed separately. (See "Classification of atrial septal defects (ASDs), and clinical features and diagnosis of isolated ASDs in children".)
The following issues need to be considered in the management of an isolated atrial septal defect (ASD) in children:
●Likelihood of spontaneous closure
●Size of a persistent ASD and degree of shunting across the defect
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- GENERAL CONSIDERATIONS
- Spontaneous closure
- Persistent defect
- - Size of the shunt and right ventricular load
- CLOSURE PROCEDURES
- - Complications
- - Outcome
- Percutaneous closure
- - Echocardiographic monitoring
- - Complications
- - Outcome
- Percutaneous closure versus surgery
- OUR MANAGEMENT APPROACH
- Criteria and timing for closure
- Choice of intervention
- Post-procedure care
- - Post-percutaneous closure
- - Post-surgical closure
- - Endocarditis prophylaxis
- LONG-TERM CARE
- Competitive sports
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS