Recent advances in managing septal defects: atrial septal defects

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.

Wire‐frame integrity of patch‐like Gore devices following atrial septal defect closure

“…A total of 91 consecutive pediatric patients (38 males; median age 5.0 years [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]; median weight 20 kg ) underwent successful GSO implantation at least 1 year before study enrollment. Patients' baseline characteristics are summarized in Table 2.…”

“…Interventional and surgical outcomes are very similar, as both procedures are associated with low complication rates . Refinements of the devices and materials have contributed to greater procedural safety and facilitated percutaneous treatment even in more complex lesions and younger infants . Despite excellent results, potential serious device‐related complications remain worrying, like cardiac erosion, device embolization, thromboembolic events, significant rhythm or conductance disturbance, as well as device fatigue failure resulting in instability and fragmentation .…”

Transcatheter Atrial Septal Defect Device Closure - A 2.5 Years Single Center Study

“…Choi et al, [9] and Woods et al, [10] stated that device closure is a safer and more effective alternative to surgery, with valid advantages in very small children, including infants and those who weigh <10kg and there was no additional risk in such small babies for transcatheter ASD closure. [11] stated that small defects <5mm are likely to spontaneously close and do not need occlusion. Evidence for right ventricular volume overloading (dilatation of right atrium and right ventricle with flat or paradoxical interventricular septal motion) by echocardiogram is used by most cardiologists as an indication for closure.…”

Autopsy in adults with congenital heart disease (ACHD)

“…As a result, shunting across the defect occurs only at atrial level [18]. Surgery abolishes the shunt and associated overload to the RV while repairing or, more rarely, replacing the atrioventricular valves [19].…”