Abstract
The purpose of this review is to discuss the management of atrial septal defects (ASD), paying particular attention to the most recent developments. There are four types of ASDs: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects. The fifth type, patent foramen ovale—which is present in 25 to 30% of normal individuals and considered a normal variant, although it may be the seat of paradoxical embolism, particularly in adults—is not addressed in this review. The indication for closure of the ASDs, by and large, is the presence of right ventricular volume overload. In asymptomatic patients, the closure is usually performed at four to five years of age. While there was some earlier controversy regarding ASD closure in adult patients, currently it is recommended that the ASD be closed at the time of presentation. Each of the four defects is briefly described followed by presentation of management, whether by surgical or percutaneous approach, as the case may be. Of the four types of ASDs, only the ostium secundum defect is amenable to percutaneous occlusion. For ostium secundum defects, transcatheter closure has been shown to be as effective as surgical closure but with the added benefits of decreased hospital stay, avoidance of a sternotomy, lower cost, and more rapid recovery. There are several FDA-approved devices in use today for percutaneous closure, including the Amplatzer® Septal Occluder (ASO), Amplatzer® Cribriform device, and Gore HELEX® device. The ASO is most commonly used for ostium secundum ASDs, the Gore HELEX® is useful for small to medium-sized defects, and the cribriform device is utilized for fenestrated ASDs. The remaining types of ASDs usually require surgical correction. All of the available treatment modes are safe and effective and prevent the development of further cardiac complications.
Highlights
Septal defects are among the most common types of congenital heart defects (CHDs) and typically present with left to right shunts. The sequelae of such defects are related to the size of the defect, amount of shunting, duration of shunting, and reactivity of the pulmonary vascular bed
We will present a classification of the atrial septal defects (ASDs), ventricular septal defects (VSDs), and atrioventricular septal defects (AVSDs), indications for closure, and a discussion of surgical and transcatheter closure approaches as well as the benefits and risks of transcatheter versus surgical intervention
Indications for ASD closure Closure of moderate to large ASDs is recommended, even in the absence of symptoms at presentation
Summary
Septal defects are among the most common types of congenital heart defects (CHDs) and typically present with left to right shunts. A cleft in the septal leaflet of the tricuspid valve may be seen in some patients These defects, formerly known as partial endocardial cushion defects, are called partial AVSDs. Ostium secundum ASD, PFO, or persistent left superior vena cava draining into the coronary sinus may coexist. Closure of the ASD along with diversion of the anomalous right pulmonary vein(s) into the left atrium are performed under cardiopulmonary bypass Sometimes this may entail constructing a tunnel with an autologous pericardial patch along with enlargement of the superior or inferior vena cava, as the case may be. Dilatation of right heart structures is similar to that portrayed for the other ASDs. Management Surgical repair with patch closure of the defect, leaving the coronary sinus opening in the left atrium, is the usual approach[59]. Grant information The author(s) declared that no grants were involved in supporting this work
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