Atrial septal defect ACC AHA guidelines for interventional and surgical therapy


 * 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
Percutaneous closure is commonly performed for ostium secundum atrial septal defect. This procedure is still not FDA approved for the treatment of other types of atrial septal defects like sinus venosus ASD, coronary sinus ASD, or primum ASD. With appropriate patient selection, percutaneous closure has been demonstrated to be as successful, safe and effective as surgical closure. Additionally, percutaneous closure has been associated with fewer complications and a reduced average length of hospital stay compared to surgical care. Surgical closure of ostium secundum atrial septal defect can be done when a concomitant tricuspid valve repair is considered or when the anatomy of the defect doesn't favor a percutaneous device. ACC/AHA recommends different interventional and surgical closure in patients with atrial septal defect depending on the associated lesions, presence and absence of atrial and ventricular hypertrophy and amount of shunting across the lesions

==ACC/AHA recommendations for interventional and surgical therapy in atrial septal defect (DONOT EDIT)==

Class I

1. Closure of an ASD either Percutaneous closure or surgically is indicated for right atrial and RV enlargement with or without symptoms. (Level of Evidence: B)

2. A sinus venosus ASD, coronary sinus ASD, or primum ASD should be repaired surgically rather than by percutaneous closure. (Level of Evidence: B)

3. Surgeons with training and expertise in CHD should perform operations for various ASD closures. (Level of Evidence: C)

Class IIa

1.Surgical closure of ostium secundum atrial septal defect is reasonable when concomitant surgical repair/replacement of a tricuspid valve is considered or when the anatomy of the defect precludes the use of a percutaneous device. (Level of Evidence: C)

2. Closure of an ASD, either percutaneously or surgically, is reasonable in the presence of:
 * 1. Paradoxical embolism. (Level of Evidence: C)
 * 2. Documented orthodeoxia-platypnea. (Level of Evidence: B)

Class IIb

1. Closure of an ASD, either percutaneously or surgically, may be considered in the presence of net left-to-right shunting, pulmonary artery pressure less than two thirds systemic levels, pulmonary vascular resistance (PVR) less than two thirds systemic vascular resistance, or when responsive to either pulmonary vasodilator therapy or test occlusion of the defect (patients should be treated in conjunction with providers who have expertise in the management of pulmonary hypertensive syndromes). (Level of Evidence: C)

2. Concomitant Maze procedure may be considered for intermittent or chronic atrial tachyarrhythmias in adults with ASDs. (Level of Evidence: C)

Class III

1. Patients with severe irreversible PAH and no evidence of a left-to-right shunt should not undergo ASD closure. (Level of Evidence: B)

For ACC/AHA Level of evidence and classes click:ACC AHA Guidelines Classification Scheme