“…Severe PAH, with possible progression to Eisenmenger physiology, ensues in a minority of patients [ 11 ]. Occasionally, a suspected paradoxical systemic thromboembolism initially raises the suspicion of an ASDII being present [ 15 ].…”
Section: Natural History and Presenting Symptomsmentioning
confidence: 99%
“…Such patients should be followed conservatively, with repeat echocardiography every 2–3 years, as shunt size may increase due to reduction in LV compliance associated with systemic hypertension and/or coronary artery disease. When a paradoxical embolism is suspected, or the rare orthodeoxia-platypnoea syndrome is documented, closure is indicated regardless of shunt size [ 9 , 15 , 24 ]. Fig.…”
Secundum atrial septal defect (ASDII) is a common congenital heart defect that causes shunting of blood between the systemic and pulmonary circulations. Patients with an isolated ASDII often remain asymptomatic during childhood and adolescence. If the defect remains untreated, however, the rates of exercise intolerance, supraventricular arrhythmias, right ventricular dysfunction and pulmonary arterial hypertension (PAH) increase with patient age, and life expectancy is reduced. Transcatheter and surgical techniques both provide valid options for ASDII closure, the former being the preferred method. With the exception of those with severe and irreversible PAH, closure is beneficial to, and thus indicated in all patients with significant shunts, regardless of age and symptoms. The symptomatic and survival benefits conferred by defect closure are inversely related to patient age and the presence of PAH, supporting timely closure after diagnosis. In this paper we review the management of adult patients with an isolated ASDII, with a focus on aspects of importance to the decision regarding defect closure and medical follow-up.
“…Severe PAH, with possible progression to Eisenmenger physiology, ensues in a minority of patients [ 11 ]. Occasionally, a suspected paradoxical systemic thromboembolism initially raises the suspicion of an ASDII being present [ 15 ].…”
Section: Natural History and Presenting Symptomsmentioning
confidence: 99%
“…Such patients should be followed conservatively, with repeat echocardiography every 2–3 years, as shunt size may increase due to reduction in LV compliance associated with systemic hypertension and/or coronary artery disease. When a paradoxical embolism is suspected, or the rare orthodeoxia-platypnoea syndrome is documented, closure is indicated regardless of shunt size [ 9 , 15 , 24 ]. Fig.…”
Secundum atrial septal defect (ASDII) is a common congenital heart defect that causes shunting of blood between the systemic and pulmonary circulations. Patients with an isolated ASDII often remain asymptomatic during childhood and adolescence. If the defect remains untreated, however, the rates of exercise intolerance, supraventricular arrhythmias, right ventricular dysfunction and pulmonary arterial hypertension (PAH) increase with patient age, and life expectancy is reduced. Transcatheter and surgical techniques both provide valid options for ASDII closure, the former being the preferred method. With the exception of those with severe and irreversible PAH, closure is beneficial to, and thus indicated in all patients with significant shunts, regardless of age and symptoms. The symptomatic and survival benefits conferred by defect closure are inversely related to patient age and the presence of PAH, supporting timely closure after diagnosis. In this paper we review the management of adult patients with an isolated ASDII, with a focus on aspects of importance to the decision regarding defect closure and medical follow-up.
“…By contrast, most adults with large shunts will experience fatigue, exercise intolerance, palpitations, syncope, and shortness of breath. Ultimately, they will suffer from rightsided heart failure, with peripheral edema, cyanosis in case of Eisenmenger syndrome, or even manifestations of thromboembolism with paradoxical emboli (37).…”
Atrial septal defects are among the third most common types of congenital heart disease. This group of malformations includes several types of atrial communications allowing shunting of blood between the systemic and the pulmonary circulations. The nature of shunting across the defect in patients with atrial septal defect is of particular interest. Understanding the underlying mechanisms of interatrial shunts and their natural history will help selecting the best timing for closure, before irreversible cardiac and pulmonary injury occur. This review describes the different pathophysiologic mechanisms involved in the direction and magnitude of blood flow through atrial septal defects. The natural history of an individual born with an isolated atrial septal defect is then discussed, including the impact of a longstanding shunt on survival.
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