Atrial septal defect and patent foramen ovale closure
Summary
An atrial septal defect (ASD) results 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 (TOE) 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. A patient’s benefit from closure is not dependent on age. 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 the stop-flow technique.
Patent foramen ovale (PFO) has been associated with “cryptogenic” ischaemic events such as stroke, transient ischaemic attack and peripheral embolism, and also with migraine and decompression illness. Detection is performed by TOE with a bubble test after e.g. a sustained Valsalva manœuvre or similarly by transthoracic echocardiography (TTE). For percutaneous closure several types...
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