ACC AHA guidelines for evaluation of unoperated patients with atrial septal defects


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. mailto:psingh@perfuse.org; ; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. mailto:kfeeney@perfuse.org

Overview
Different modalities of treatment could be used to diagnose and determine the amount of shunting across the atrial septal defect. Maximal exercise testing can be used in patients with symptoms that are discrepant with clinical findings or to document changes in oxygen saturation in patients with mild or moderate pulmonary artery hypertension.

==ACC / AHA Guidelines - Evaluation of the Unoperated Patient (DO NOT EDIT) == {{cquote|

Class I
1) ASD should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of RV volume overload and any associated anomalies. (Level of Evidence: C)

2) Patients with unexplained RV volume overload should be referred to an ACHD center for further diagnostic studies to rule out obscure ASD, partial anomalous venous connection, or coronary sinoseptal defect. (Level of Evidence: C)

Class IIa
1) Maximal exercise testing can be useful to document exercise capacity in patients with symptoms that are discrepant with clinical findings or to document changes in oxygen saturation in patients with mild or moderate PAH. (Level of Evidence: C)

2) Cardiac catheterization can be useful to rule out concomitant coronary artery disease in patients at risk because of age or other factors. (Level of Evidence: B)

Class III
1) In younger patients with uncomplicated ASD for whom imaging results are adequate, diagnostic cardiac catheterization is not indicated. (Level of Evidence: B)

2) Maximal exercise testing is not recommended in ASD with severe PAH. (Level of Evidence: B)

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