Contemporary Clinical Management of Atrial Septal Defects in the Adult

Gianluca Rigatelli; Paolo Cardaioli; Ziyad M Hijazi

Disclosures

Expert Rev Cardiovasc Ther. 2007;5(6):1135-1146. 

In This Article

Summary & Conclusion

Adults with isolated ASD are more likely to reach adult age without being diagnosed: this diagnosis should be kept in mind in presence of symptoms and signs of pulmonary overload. This review article shows that all the diagnostic and therapeutical advancements developed in the last 6 years have made the diagnosis and treatment simpler and faster even in most complex cases. Standard echocardiography is the first-line imaging modality to confirm suspicion of such defects. 3D echocardiography and MRIs are the most modern and more promising techniques in case of difficult diagnosis. Although the poor number of comparative studies and the lack of randomized trials comparing surgical with percutaneous closure in uncomplicated secundum ASD does not allow any clear recommendations in respect of complications and economic cost, some indications can be retrieved form the literature. Percutaneous device-based closure or conventional or mini-invasive surgery should be proposed on the basis of types of defects (secundum, primum or sinus defects). In case of secundum ASD, decision about surgery or device-based closure should be made on the basis of anatomical characteristics of the defect. Currently, percutaneous closure seems to be the first choice in uncomplicated defects with sufficient rims, whereas mini-invasive surgery seems indicated in case of difficult anatomy, poor rims or defects larger than 40 mm.

Meticulous patients' selection and judicious follow-up appear mandatory in order to deliver proper care to different types of ASDs and assist them after repair with modern follow-up strategies (Figure 4).

Summary algorithm for management of operated and non operated patients with different types of atrial septal defects. ASD: Atrial septal defect.

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