Atrial septal defect: closure, monitoring and contraindications
THE CONTEXT
Management depends on the magnitude of pulmonary flow and the presence of pulmonary hypertension or shunt reversal.
Closure and conservative management
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Defects with pulmonary flow 50% above systemic flow, a pulmonary-to-systemic flow ratio of 1.5:1, are often clinically recognisable and should be closed surgically.
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Smaller defects may be managed conservatively with periodic echocardiographic monitoring.
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Closure can also be performed during cardiac catheterisation using implantable closure devices.
Prognosis and contraindications
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Long-term prognosis after closure is excellent unless pulmonary hypertension has developed.
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Severe pulmonary hypertension and shunt reversal are both contraindications to surgery.