Atrial septal defect: spectrum of care

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Atrial septal defect (ASD) is a prevalent congenital heart defect with existing variability in clinical management.
• A lack of standardized guidelines for the evaluation and management of different ASD types necessitates further investigation into current practices.

Purpose of the Study:

• To assess the uniformity of diagnostic and therapeutic approaches for secundum, sinus venosus, and primum ASDs in pediatric cardiology.
• To identify variations in follow-up, diagnostic studies, pharmacological therapy, and repair methods across different ASD types and sizes.

Main Methods:

• A survey-based study distributed questionnaires to pediatric cardiology academic programs in the US and internationally.
• Questionnaires addressed follow-up, diagnosis, and therapeutic interventions for secundum, primum, and sinus venosus ASDs, categorized by defect size (small, moderate, large).
• Response data from 23 programs were analyzed to compare management strategies.

Main Results:

• Secundum ASD management primarily relies on defect size and right-sided volume overload criteria.
• Follow-up frequency correlates with defect size and patient symptomatology, with larger defects requiring more frequent visits (3-6 months).
• Echocardiography is the predominant follow-up modality (>80%); pharmacological therapy is favored for primum ASD; percutaneous closure is preferred for secundum ASD.

Conclusions:

• Significant variability exists in the management of different ASD types, particularly regarding pharmacological therapy and pre-repair investigations.
• Timing of repair is primarily dictated by patient age and symptoms, with associated anomalies influencing decisions for primum and sinus venosus ASDs.
• There is general agreement on indefinite postoperative follow-up, especially for larger defects.