**Section 5**

**ASD Closure in Adults and Elderly** 

118 Atrial Septal Defect

Schwartz SL, Gillam LD & Weintraub AR et al: Intracardiac echocardiography in humans

imaging planes and clinical experience. J Am Coll Cardiol 1993; 21:189.

using a small-sized (6F), low frequency (12.5 MHz) ultrasound catheter: methods,

**8**

 *USA* 

**Why, When and How Should Atrial Septal** 

The most common defects in the atrial septum are ostium secundum, ostium primum and sinus venosus atrial septal defects (ASDs) and patent foramen ovale. The management of ostium primum and sinus venosus defects is by surgery because of associated abnormalities, namely, cleft in the mitral valve causing mitral regurgitation in ostium primum defects and partial anomalous pulmonary venous connection in sinus venosus defects and is addressed in Chapter 1. Patent foramen ovale (PFO) in relation to presumed paradoxical embolism, platypnea-orthodeoxia syndrome, migraine, decompression illness and others may also require closure and the considerations for closure of such PFOs are different than those of closure of ostium secundum ASDs and some of these are discussed in other chapters in this book and will not be addressed in this chapter. In this chapter only ostium secundum ASDs in adult subjects will be discussed; I will address issues related to why, when and how should atrial septal defects be closed in these subjects. The methods of transcatheter closure in adults will also be reviewed as are the approaches to occlude complex forms of ASD.

In the past it was generally thought that closure ASDs in adult subjects is not necessary if they are not symptomatic. Some early studies (Ward 1994, Gatzoulis et al 1996, Webb 2001) suggested that there is no major benefit if surgical closure is performed in adulthood. Based on more recent analysis however, it would appear that the ASDs should be closed as and when they are identified. The purpose of this section of this chapter is to present evidence

In this section I will review some of the published evidence supporting closure of ASDs in

In a follow-up study (Rosas et al 2004) of 200 patients older than 40 years (49 ± 9 years) with unrepaired ASD for 2 to 22 years, it was found that 37 (18.5%) had major events, namely

**2. Why should atrial septal defects be closed in adults?** 

that the ASDs in adults should be closed.

all adults

**2.1 Evidence in favor of closing ASDs in adults** 

**2.1.1 Complications in unrepaired ASD patients** 

**1. Introduction** 

**Defects Be Closed in Adults** 

*University of Texas at Houston Medical School, Houston, TX,* 

P. Syamasundar Rao
