Atrial Septal Defect

What are the types of ASD?

There are 4 types of defect noted in atrial septum:

  • OstiumSecundum (OS-ASD) ASD: True ASD
  • OstiumPrimum Defect
  • Sinus venosus (SVC and IVC types) Defects
  • Coronary sinus type defect

Ostiumsecundum atrial septal defect is the most common type.

Clinical presentation of isolated ASD?

Majority of children are asymptomatic with ASD. Rarely may have poor weight gain, cough, cold etc.

As majority is asymptomatic, ASD can be easily missed in day to day examination by his/her child heart specialist. Some patients are coming in late adulthood with diagnosis of ASD.

By careful examining the child, chest x-ray or ECG, we can suspect ASD.

Timing of closure of ASDs?

Ostiumsecundum ASDs are closed between 2-4 years of age.

Ostiumprimum defect: if not associated with other cardiac defects, then we can follow and can close between 2-3 years of age; and if associated with moderate to severe mitral valve regurgitation (MR) then we should close by one year of age.

Sinus venous type of defect: We generally close by 4-5 years of age.

Which method is suitable for closure of ASDs?

Ostiumsecundum(OS-ASD) ASD: There are two options: Either surgical closure or by transcatheter method if suitable for device closure.

For other varieties of ASDs: Surgery is treatment of choice.

Which method is suitable for ostiumsecundum ASDs (OS-ASD: Device ottranscatheter closure, or surgical closure?

This type of ASD can be closed either by surgery or by using a device in cath lab by angiography.

Closing by method is decided by size of ASD and weight of child as well as surrounding margins of ASD.

If size of ASD is moderate (not very large in size) with good surrounding margins with accepted weight of the child, then device closure method is the treatment of choice.

If not then surgery is treatment of choice.

Advantages of ASD closure by using Device (Non-surgical method)?
  1. Short hospital stay (2-3 days)
  2. No surgical scar on the body
  3. Only one tab needs to be taken for 6 months
  4. Can attend school from next day of discharge
  5. Can participate in all outdoor activities from very next day
  6. Very less risk as compared to surgery, although very safe procedure
  7. No requirement  of ventilator in most cases
Medicine to be used after device closure?

Only tab Aspirin to be taken for 6 months after device closure.

How we should do follow-up after device closure or after surgery?

After Device closure by angiographically: After one month then 3, 6, 12 months after the procedure.

After surgery: after 3 days for wound dressing, then 1, 3, 6, 12 months after surgery.