Indications for closure and medical management of atrial septal defects in adults
- Heidi M Connolly, MD, FASE
Heidi M Connolly, MD, FASE
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
Atrial septal defect (ASD) is the most common congenital lesion in adults after bicuspid aortic valve. Although the defect often causes no symptoms 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 — Atrial septal defect (ASD) closure is indicated in the following settings:
●For patients with a significant left-to-right shunt from the ASD as evidenced by right ventricular volume overload without pulmonary arterial hypertension, with or without symptoms. (See 'Right ventricular volume overload' below.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INDICATIONS FOR DEFECT CLOSURE
- Right ventricular volume overload
- - Evidence
- - Qp/Qs criterion not required
- - In selected patients with pulmonary hypertension
- Paradoxical embolization
- MEDICAL MANAGEMENT WITH OR WITHOUT REPAIR
- Atrial arrhythmias
- Pulmonary hypertension
- Endocarditis prophylaxis
- - Unrepaired ASD
- - Repaired ASD
- - Genetic factors
- Participation in sports
- ISSUES WITH UNREPAIRED ASDS
- Scuba diving
- High altitude exposure
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS