Patients with simple congenital heart disease such as isolated atrial septal defects (ASDs) are rapidly becoming a relatively large population with a variety of clinical problems that are often missed by pediatric physicians or grown up congenital heart disease specialists, and may involve different adult health professionals such as general cardiologists or internists. Isolated ASDs are common (7% of all cardiac anomalies) and can present at any age, sometimes in conjunction with other genetic disorders such as Down’s syndrome or in a familiar form. The diagnosis is often accidental: Doppler echocardiography and, recently, magnetic resonance imaging are mandatory to assess types and significance of ASDs. Surgical or percutaneous repair should be offered at any age unless associated with pulmonary vascular disease: Percutaneous closure should be preferred in isolated secundum ASD with sufficient rims on trans-esophageal echocardiography, whereas surgery remains the only option for primum and sinus defects. Follow-up of operated patients is based on Holter EKG and echocardiography that should be scheduled every 2 years for secundum and sinus defects and every year for primum defect with valve repair. ASDs in adolescents and adults may be suspected in any physician’s office and doctors should be acquainted with innovative imaging techniques and contemporary therapeutic options in order to deliver proper care to different types of ASDs and assist them after repair with appropriate follow-up strategies.
1. Marelli AJ, Mackie AS, Ionescu-Ittu R, Rahme E, Pilote L. Congenital heart disease in the general population: Changing prevalence and age distribution. Circulation 2007;115:163-72.
2. Rigatelli G, Rigatelli G. Congenital heart diseases in aged patients: Clinical features, diagnosis, and therapeutic indications based on the analysis of a twenty five-year Medline search. Cardiol Rev 2005;13:293-6.
3. Bernier FP, Spaetgens R. The geneticist’s role in adult congenital heart disease. Cardiol Clin 2006;24:557-69.
4. Webb G, Gatzoulis MA. Atrial septal defects in the adult: Recent progress and overview. Circulation 2006;114:1645-53.
5. Ayres NA, Miller-Hance W, Fyfe DA, Stevenson JG, Sahn DJ, Young LT, et al; Pediatric Council of the American Society of the Echocardiography. Indications and guidelines for performance of transesophageal echocardiography in the patient with pediatric acquired or congenital heart disease: Report from the task force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr 2005;18:91-8.
6. Fredriksen PM, Veldtman G, Hechter S, Therrien J, Chen A, Warsi MA, et al. Aerobic capacity in adults with various congenital heart diseases. Am J Cardiol 2001;87:310-4.
7. Hausmann D, Daniel WG, Mugge A, Ziemer G, Pearlman AS. Value of transesophageal color Doppler echocardiography for detection of different types of atrial septal defect in adults. J Am Soc Echocardiogr 1992;5:481-8.
8. Munoz-Castellanos L, Espinola-Zavaleta N, Kuri-Nivon M, Ruiz JF, Keirns C. Atrial septal defect: Anatomoechocardiographic correlation. J Am Soc Echocardiogr 2006;19:1182-9.
9. van den Bosch AE, Ten Harkel DJ, McGhie JS, Roos-Hesselink JW, Simoons ML, Bogers AJ, et al. Characterization of atrial septal defect assessed by real-time 3-Dimensional echocardiography. J Am Soc Echocardiogr 2006;19:815-21.
10. Marcu CB, Beek AM, van Rossum AC. Clinical applications of cardiovascular magnetic resonance imaging. CMAJ 2006;175:911-7.
11. Weber OM, Higgins CB. MR evaluation of cardiovascular physiology in congenital heart disease: Flow and function. J Cardiovasc Magn Reson 2006;8:607-17.
12. Attie F, Rosas M, Granados N, Zabal C, Buendia A, Calderon J. Surgical treatment for secundum atrial septal defects in patients >40 years old. A randomized clinical trial. J Am Coll Cardiol 2001;38:2035-42.
13. Butera G, Biondi-Zoccai G, Sangiorgi G, Abella R, Giamberti A, Bussadori C, et al. Percutaneous versus surgical closure of secundum atrial septal defects: A systematic review and meta-analysis of currently available clinical evidence. EuroIntervention 2011;7:377-85.
15. Shahriari A, Rodefeld MD, Turrentine MW, Brown JW. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg 2006;81:224-9.
16. Salehian O, Horlick E, Schwerzmann M, Haberer K, McLaughlin P, Siu SC, et al. Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. J Am Coll Cardiol 2005;45:499-504.
17. Rigatelli G, Dell’avvocata F, Cardaioli P, Giordan M, Dung HT, Nghia NT, et al. Safety and long-term outcome of modified intracardiac echocardiography-assisted “no-balloon” sizing technique for transcatheter closure of ostium secundum atrial septal defect. J Interv Cardiol 2012;25:628-34.
18. Hijazi Z, Wang Z, Cao Q, Koenig P, Waight D, Lang R. Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: Feasibility and comparison with transesophageal echocardiography. Catheter Cardiovasc Interv 2001;52:194-9.
19. Zanchetta M, Onorato E, Rigatelli G, Pedon L, Zennaro M, Carrozza A, et al. Intracardiac echocardiography-guided transcatheter closure of secundum atrial septal defect: A new efficient device selection method. J Am Coll Cardiol 2003;42:1677-82.
20. Rigatelli G, Hijazi ZM. Intracardiac echocardiography in cardiovascular catheter-based interventions: Different devices for different purposes. J Invasive Cardiol 2006;18:225-33.
21. Mylotte D, Quenneville SP, Kotowycz MA, Xie X, Brophy JM, Ionescu- Ittu R, et al. Long-term cost-effectiveness of transcatheter versus surgical closure of secundum atrial septal defect in adults. Int J Cardiol 2014;172:109-14.
22. Doll N, Walther T, Falk V, Binner C, Bucerius J, Borger MA, et al. Secundum ASD closure using a right lateral minithoracotomy: Fiveyear experience in 122 patients. Ann Thorac Surg 2003;75:1527-30.
23. Casselman FP, Dom H, De Bruyne B, Vermeulen Y, Vanermen H. Thoracoscopic ASD closure is a reliable supplement for percutaneous treatment. Heart 2005;91:791-4.
24. Liang T, XiangJun Z, XiaoJing M, Yun L, Leng CY. New minimally invasive technique to occlude secundum atrial septal defect in 53 patients. Ann Thorac Surg 2006;81:1417-9.
25. Suchon E, Pieculewicz M, Tracz W, Przewlocki T, Sadowski J, Podolec P. Transcatheter closure as an alternative and equivalent method to the surgical treatment of atrial septal defect in adults: Comparison of early and late results. Med Sci Monit 2009;15:CR612-7.
26. Kutty S, Hazeem AA, Brown K, Danford CJ, Worley SE, Delaney JW, et al. Long-term (5- to 20-year) outcomes after transcatheter or surgical treatment of hemodynamically significant isolated secundum atrial septal defect. Am J Cardiol 2012;109:1348-52.
27. Costa RN, Ribeiro MS, Pereira FL, Pedra SR, Jatene MB, Jatene IB, et al. Percutaneous versus surgical closure of atrial septal defects in children and adolescents. Arq Bras Cardiol 2013;100:347-54.
28. Kotowycz MA, Therrien J, Ionescu-Ittu R, Owens CG, Pilote L, Martucci G, et al. Long-term outcomes after surgical versus transcatheter closure of atrial septal defects in adults. JACC Cardiovasc Interv 2013;6:497-503.
29. Fischer G, Stieh J, Uebing A, Hoffmann U, Morf G, Kramer HH. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: A single centre study in 236 consecutive patients. Heart 2003;89:199-204.
30. Butera G, Carminati M, Chessa M, Delogu A, Drago M, Piazza L, et al. CardioSEAL/STARflex versus Amplatzer devices for percutaneous closure of small to moderate (up to 18 mm) atrial septal defects. Am Heart J 2004;148:507-10.
31. Wang JK, Tsai SK, Wu MH, Lin MT, Lue HC. Short- and intermediateterm results of transcatheter closure of atrial septal defect with the Amplatzer Septal Occluder. Am Heart J 2004;148:511-7.
32. Zanchetta M, Rigatelli G, Pedon L, Zennaro M, Carrozza A, Onorato E, et al. Transcatheter atrial septal defect closure assisted by intracardiac echocardiography: 3-year follow-up. J Interv Cardiol 2004;17:95-8.
33. Masura J, Gavora P, Podnar T. Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders. J Am Coll Cardiol 2005;45:505-7.
34. Vida VL, Barnoya J, O’Connell M, Leon-Wyss J, Larrazabal LA, Castaneda AR. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: Results and cost-effective considerations in a low-income country. J Am Coll Cardiol 2006;47:326-31.
35. Rigatelli G, Dell’Avvocata F, Cardaioli P, Giordan M, Braggion G, Aggio S, et al. Five-year follow-up of transcatheter intracardiac echocardiography-assisted closure of interatrial shunts. Cardiovasc Revasc Med 2011;12:355-61.
36. Grohmann J, Höhn R, Fleck T, Schmoor C, Stiller B. Transcatheter closure of atrial septal defects in children and adolescents: Singlecenter experience with the GORE® septal occluder. Catheter Cardiovasc Interv 2014 Mar 24.
37. Saritas T, Kaya MG, Lam YY, Erdem A, Akdeniz C, Demir F, et al. A comparative study of Cardi-O-Fix septal occluder versus Amplatzer septal occluder in percutaneous closure of secundum atrial septal defects. Catheter Cardiovasc Interv 2013;82:116-21.
38. Aytemir K, Oto A, Ozkutlu S, Kaya EB, Canpolat U, Yorgun H, et al. Early-mid term follow-up results of percutaneous closure of the interatrial septal defects with cclutech figulla devices: A single center experience. J Interv Cardiol 2012;25:375-81.
39. Silversides CK, Siu SC, McLaughlin PR, Haberer KL, Webb GD, Benson L, et al. Symptomatic atrial arrhythmias and transcatheter closure of atrial septal defects in adult patients. Heart 2004;90:1194-8.
40. Roos-Hesselink JW, Meijboom FJ, Spitaels SE, van Domburg R, van Rijen EH, Utens EM, et al. Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21-33 years. Eur Heart J 2003;24:190-7.
41. Brochu MC, Baril JF, Dore A, Juneau M, De Guise P, Mercier LA. Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation 2002;106:1821-6.
42. Giardini A, Moore P, Brook M, Stratton V, Tacy T. Effect of transcatheter atrial septal defect closure in children on left ventricular diastolic function. Am J Cardiol 2005;95:1255-7.
43. Nyboe C, Fenger-Grøn M, Nielsen-Kudsk JE, Hjortdal V. Closure of secundum atrial septal defects in the adult and elderly patients. Eur J Cardiothorac Surg 2013;43:752-7.
44. Veldtman GR, Razack V, Siu S, El-Hajj H, Walker F, Webb GD, et al. Right ventricular form and function after percutaneous atrial septal defect device closure. J Am Coll Cardiol 2001;37:2108-13.
45. Guo JJ, Luo YK, Chen ZY, Cao H, Yan XP, Chen H, et al. Long-term outcomes of device closure of very large secundum atrial septal defects: A comparison of transcatheter vs intraoperative approaches. Clin Cardiol 2012;35:626-31.
46. Kong H, Wilkinson JL, Coe JY, Gu X, Urness M, Kim TH, Bass JL. Corrosive behaviour of Amplatzer devices in experimental and biological environments. Cardiol Young 2002;12:260-5.
47. Vida VL, Berggren H, Brawn WJ, Daenen W, Di Carlo D, Di Donato R, et al. Risk of surgery for congenital heart disease in the adult: A multicentered European study. Ann Thorac Surg 2007;83:161-8.
48. Pees C, Haas NA, von der Beek J, Ewert P, Berger F, Lange PE. Cardiac troponin I is increased after interventional closure of atrial septal defects. Catheter Cardiovasc Interv 2003;58:124-9.
49. Amin Z, Hijazi ZM, Bass JL, Cheatham JP, Hellenbrand WE, Kleinman CS. Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects: Review of registry of complications and recommendations to minimize future risk. Catheter Cardiovasc Interv 2004;63:496-502.
50. Amin Z. Echocardiographic predictors of cardiac erosion after Amplatzer septal occluder placement. Catheter Cardiovasc Interv 2014;83:84-92.
51. Krumsdorf U, Ostermayer S, Billinger K, Trepels T, Zadan E, Horvath K, et al. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol 2004;43:302-9.
52. Therrien J, Warnes C, Daliento L, Hess J, Hoffmann A, Marelli A, et al. Canadian Cardiovascular Society Consensus Conference 2001 update: Recommendations for the management of adults with congenital heart disease part III. Can J Cardiol 2001;17:1135-58.
53. 32nd Bethesda Conference. Care of Adult with Congenital Heart Disease October 2-3 2000.
54. The Netherlands heart Foundation. Adult congenital heart disease in the Netherlands. Guidelines 2000. The Hague 2000.
55. Wren C, O’Sullivan JJ. Survival with congenital heart disease and need for follow-up in adult life. Heart 2001;85;438-43.
56. Uebing A, Steer PJ, Yentis SM, Gatzoulis MA. Pregnancy and congenital heart disease. BMJ 2006;332:401-6.
57. Hirth A, Reybrouck T, Bjarnason-Wehrens B, Lawrenz W, Hoffmann A. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: A consensus document. Eur J Cardiovasc Prev Rehabil 2006;13:293-9.
58. Deanfield J, Thaulow E, Warnes C, Webb G, Kolbel F, Hoffman A, et al. The Task Force on the Management of Grown Up Congenital Heart Disease of the European Society of Cardiology. Management of Grown Up Congenital Heart Disease. Eur Heart J 2003; 24:1035-84.
59. Dell’avvocata F, Rigatelli G, Cardaioli P, Giordan M. Home-made fenestrated amplatzer occluder for atrial septal defect and pulmonary arterial hypertension. J Geriatr Cardiol 2011;8:127-9.
60. Sulica R, Poon M. Medical therapeutics for pulmonary arterial hypertension: From basic science and clinical trial design to evidencebased medicine. Expert Rev Cardiovasc Ther 2005;3:347-60.
61. Frost AE, Quinones MA, Zoghbi WA, Noon GP. Reversal of pulmonary hypertension and subsequent repair of atrial septal defect after treatment with continuous intravenous epoprostenol. J Heart Lung Transplant 2005;24:501-3.
62. Taniguchi Y, Emoto N, Miyagawa K, Nakayama K, Kinutani H, Tanaka H, et al. Subsequent shunt closure after targeted medical therapy can be an effective strategy for secundum atrial septal defect with severe pulmonary arterial hypertension: Two case reports: Strategy for ASD with severe PAH. Heart Vessels 2014;29:282-5.