pediatrics
Atrial Septal Defect (ASD)
Treatment of ASD
Observation, transcatheter closure, or surgical repair Most small (<3 mm), centrally located atrial septal defects close spontaneously; many defects between 3 mm and 8 mm close spontaneously by age 3 years. These defects probably represent a stretched patent foramen ovale rather than true secundum ASDs. Ostium primum ASDs and sinus venosus ASDs do not close spontaneously. Asymptomatic children with a small shunt require only observation and occasional echocardiography (typically about every 3 to 5 years). Although these children are theoretically at risk of paradoxical systemic embolization, this event is rare in childhood. Thus, it is not standard practice to close a small, hemodynamically insignificant defect. Moderate-to-large ASDs (evidence of right ventricular volume overload on echocardiography) should be closed, typically between ages 2 years and 6 years. Repair may be considered earlier in children with chronic lung disease. Transcatheter closure with various commercial closure devices is possible in 85 to 90% of defects and is preferred when appropriate anatomic characteristics, such as adequate rims of septal tissue and distance from vital structures (eg, aortic root, pulmonary veins, tricuspid annulus), are present ( Treatment reference ). Otherwise, surgical repair is indicated. Sinus venosus and ostium primum (atrioventricular septal type) defects are not amenable to device closure. If ASDs are repaired during childhood, perioperative mortality rate approaches 0, and long-term survival rates approach those of the general population. Prevention is not needed preoperatively and is required only for the first 6 months after repair or if there is a residual defect adjacent to a surgical patch. 1.Faccini A, Butera G: Atrial septal defect (ASD) device trans-catheter closure: limitations.J Thorac Dis10 (Suppl 24):S2923–S2930, 2018. 