Atrial septal defect closure

Introduction

An atrial septal defect (ASD) results usually in a left-to-right shunt. The status of the right ventricle (RV) reflects the haemodynamic burden and defines whether an ASD is significant. Transoesophageal echocardiography (TEE) allows the evaluation of defect localisation and size, enlargement of heart chambers and evidence of sufficient rims for percutaneous closure of a secundum ASD. Closure of an ASD leads to a symptomatic improvement and regression of RV size and pulmonary hypertension.

The success rate for percutaneous closure of secundum ASDs is very high with a complete closure rate of more than 95%, and a low rate of complications. The most important key to success is a pre-interventional check whether the ASD is suitable for percutaneous closure. The device size is usually selected after measuring the ASD using a sizing balloon with stop flow technique. This short review gives a number of tips and tricks that successful operators can integrate into their clinical practice in order to ensure the best possible patient outcomes.

Clinical assessment of the patient

The value of a meticulous history and careful clinical examination cannot be overestimated. Symptoms of exertional dyspnoea, exercise intolerance, recurrent chest infections and arrhythmias are variable, and are dependent upon the size...