Secundum atrial septal defects in adults: all you need to know with an emphasis on outcome

Abstract

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.

Keywords: Atrial septal defect; adult congenital heart disease; left to right intracardiac shunts; surgical atrial septal defect closure; transcatheter atrial septal defect closure.