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Surgical and percutaneous closure of atrial septal defects in adults

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


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 surgical and percutaneous closure of ASDs in adults.

Indications for ASD closure, medical management, 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 "Indications for closure and medical management of atrial septal defects in adults" and "Management and outcome of isolated atrial septal defects in children" 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".)


Preprocedural assessment in patients with indications for atrial septal defect (ASD) closure includes review of the transthoracic echocardiogram. Some patients require additional testing such as transesophageal echocardiogram (TEE), cardiovascular computerized tomography (CT), or cardiac magnetic resonance (CMR) imaging to confirm the diagnosis and identify or exclude associated defects prior to surgical or percutaneous closure. In patients with pulmonary hypertension, cardiac catheterization may be needed to determine the best management strategy.

Conditions that are likely to require surgical correction should be identified prior to intervention:

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Literature review current through: Nov 2017. | This topic last updated: Nov 21, 2017.
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