Secundum atrial septal defect in adults: a practical review and recent developments

Abstract

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.

Normalisation of hypoxaemia following successful percutaneous closure of a bidirectional shunting secundum atrial septal defect without pulmonary hypertension in a patient with severe non‐ischaemic cardiomyopathy and refractory ventricular tachycardia

“…A long‐standing left‐to‐right shunt can lead to pulmonary hypertension (the single most influential factor in the clinical course of ASD) with eventual reversal of shunting in some cases (Eisenmenger syndrome). Increased pulmonary vascular resistance, resulting in cyanosis, RV failure and premature death . The magnitude of atrial shunting is dependent on both LV and RV compliance (as seen in our case), systemic and pulmonary vascular resistance and the size of the defect.…”

“…ASD are the second most common congenital heart defect and account for 40% of congenital heart defects presenting in adulthood . Although the majority of ASD are sporadic, rare genetic syndromes are associated with the formation of these defects . Multiple types of ASD exist; however, 75% are ostium secundum ASD resulting from the excessive resorption of the atrial septum primum, causing an absent fossa ovalis area .…”

“…2 Multiple types of ASD exist; however, 75% are ostium secundum ASD resulting from the excessive resorption of the atrial septum primum, causing an absent fossa ovalis area. 2 Unlike other types of ASD, ostium secundum ASD are usually amendable to transcatheter closure. Untreated, patients often become symptomatic in their fifth decade with exertional dyspnoea and, commonly, fatigue.…”

Tailored circulatory intervention in adults with pulmonary hypertension due to congenital heart disease

“…If the PVR exceeds this value but is less than two-thirds of the systemic resistance, intervention can still be considered. In line with this, the effective left-right shunt ratio (Qp:Qs) should be at least 1.5 in the case of a bidirectional shunt, as this inversely relates to the ratio between systemic and pulmonary vascular resistance [2,[13][14][15]. RV dilatation, dysfunction and pulmonary regurgitation are other indications for intervention, although manifest RV failure inherently increases procedural risk [13].…”

A Case of Sudden Death Due to Persistent Severe Pulmonary Arterial Hypertension After Late Atrial Septal Defect Closure

“…Atrial septal defects (ASDs) are one of the most prevalent congenital cardiac anomalies in adults . These interatrial communications allow blood to flow between the atria of the heart.…”