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  • • A congenital heart lesion that increases pulmonary artery (PA) blood flow

    • Causes left to right shunt, results in lung infection, pulmonary vascular congestion, PA hypertension, right heart failure, pulmonary vasoconstriction, pulmonary vascular obstructive disease

    Eisenmenger syndrome: Increased pulmonary hypertension to such extent that left to right shunt ceases and shunt becomes right to left, requiring heart-lung transplant

    • Inhaled nitric oxide, oxygen, or IV tolazoline reverses PA vasoconstriction

    • PA band is palliative and can reduce PA flow to alleviate RV failure and progression of pulmonary hypertension

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Epidemiology

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  • Ostium secundum type: Most common and largest of ASDs

    • Defects high in atrial septum, associated with partial anomalous pulmonary venous return, termed "sinus venosus defects"

    • Reduced life expectancy because of RV failure, arrhythmias, pulmonary vascular disease

    • Pulmonary vascular disease rare

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Symptoms and Signs

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  • • Acyanotic, asymptomatic often

    • RV lift

    • S2 widely split and fixed

    • Pulmonary systolic ejection murmur

    • Diastolic flow murmur at left lower sternal border

    • Heart failure may occur in kids, rare in adults

    • Atrial dysrhythmias increase with age

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Imaging Findings

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  • • Echocardiography: Diagnostic

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  • • Evaluate for other associated cardiac or extracardiac anomalies

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  • • Echocardiography

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  • • Most should be closed

    • Optimal time debated

    • Paradoxic embolism and endocarditis associated with delaying repair

    • Open surgery is performed to close if patient is 1 or 2 years old

    • Many now are closed percutaneously (patient must weigh > 10 kg)

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Surgery

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Indications

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  • • Presence of ASD in low- to moderate- risk patient

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Prognosis

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  • • Excellent

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References

Christensen DD, Vincent RN, Campbell RM: Presentation of atrial septal defect in the pediatric population. Pediatr Cardiol 2005;26:812.  [PubMed: 16235001]
Cowley CG et al: Comparison of results of closure of secundum atrial septal defect by surgery versus Amplatzer septal occluder. Am J Cardiol 2001;88:589.  [PubMed: 11524080]
Hopkins RA et al: Surgical patch closure of atrial septal defects. Ann Thorac Surg 2004;77:2144.  [PubMed: 15172284]
Krasuski RA: When and how to fix a “hole in the heart”: approach to ASD and PFO. Cleve Clin J Med 2007;74:137.  [PubMed: 17333641]
Purcell IF, Brecker SJ, Ward DE: Closure of defects of the atrial septum in adults using the Amplatzer device: 100 consecutive patients in a single center. Clin Cardiol 2004;27:509.  [PubMed: 15471162]

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