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 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) . 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'.)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
- - Qp/Qs ratio
- - In selected patients with pulmonary hypertension
- Paradoxical embolization
- Supporting data
- 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