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Evaluation and treatment of abnormalities of the interatrial septum

An atrial septal defect (ASD) was first described by Leonardo da Vinci in 1513. It constitutes the most common (about 1/3 of cases) congenital cardiac abnormality first diagnosed in adults. Most sizeable defects have significant long-term hemodynamic consequences, warranting surgical or percutaneous closure for prognostic reasons. More recently, other congenital abnormalities of the interatrial septum, such as patent foramen ovale (PFO) and atrial septal aneurysm (ASA), have been increasingly recognized as potential mediators of several disease manifestations, including paradoxical embolism, orthostatic desaturation in the setting of the platypneaorthodeoxia syndrome, refractory hypoxemia due to right-to-left shunt in patients with right ventricular infarction or severe pulmonary disease, neurological decompression illness in divers, and migraine with aura. The anatomy of the interatrial septum, the available diagnostic techniques, and the therapeutic options in symptomatic patients will be reviewed.