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Updated: May 10, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Secundum atrial septal defects in adults: all you need to know with an emphasis on outcome
1Department of Cardiovascular Disease, Sidra Medicine, Doha, Qatar.
Insights
Secundum atrial septal defects (ASD) are common in adults and may require closure. Device closure is preferred over surgery for secundum ASDs due to better outcomes and fewer complications.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Adult Congenital Heart Disease
Background:
- Atrial septal defect (ASD) is the most prevalent congenital heart disease in adults.
- Secundum ASD is the most common anatomical type, often asymptomatic in childhood but symptomatic in adulthood due to increased left-to-right shunting.
- Closure is indicated for clinically significant shunts, evidenced by echocardiographic right-sided dilation, Qp:Qs ratio > 1.5:1, or symptoms.
Purpose of the Study:
- To review secundum atrial septal defects (ASD) in adults.
- To compare the outcomes of device closure versus surgical closure for secundum ASDs.
- To cover ASD anatomy, pathophysiology, clinical presentation, natural history, imaging, and closure indications.
Main Methods:
- Review of secundum atrial septal defects (ASD) in adult patients.
- Emphasis on comparing device closure outcomes with surgical approaches.
- Discussion of ASD anatomy, pathophysiology, clinical presentation, natural history, imaging, and closure indications.
Main Results:
- Transcatheter device closure is the preferred method for secundum ASDs globally.
- Device closure is more cost-effective, involves shorter hospital stays, and has comparable outcomes with fewer complications than surgery.
- The review covers suitability for transcatheter closure based on anatomical criteria.
Conclusions:
- Transcatheter device closure is a safe and effective alternative to surgical repair for secundum ASDs.
- Device closure offers advantages in terms of cost, hospital stay, and complication rates.
- Secundum ASD management in adults should consider transcatheter closure when anatomical criteria are met.
Introduction:
Atrial septal defect is the most common congenital heart disease in adults. The secundum defect is the most common anatomical variant. Atrial septal defect usually causes subtle or no symptoms in pediatrics. However, as patients age, the left-to-right shunt increases and more symptoms appear. Atrial septal defect closure is indicated when there is a clinically significant left-to-right shunt, either by echocardiographic data in terms of right-sided dilation, hemodynamic parameters with Qp:Qs ratio over 1.5:1, or the appearance of clinical symptoms.
Areas Covered:
This article reviews secundum atrial septal defects (ASD) with emphasis on device closure outcome in comparison to surgical approaches. The article covers ASD anatomy, pathophysiology, clinical presentation, natural history, imaging evaluation, indications for closure, suitability for transcatheter closure, and outcome of both device closure and surgical closure in the adult patients.
Expert Opinion:
Atrial septal defect closure can be performed either via a transcatheter approach or a surgical approach. The transcatheter approach is preferred worldwide to close secundum ASDs, provided they meet certain anatomical criteria (size and rim sufficiency). The transcatheter approach is more cost-effective, requires a shorter hospital stay, and has similar outcomes with a lower incidence of complications.
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