8th March 2024

Management

Medical management is not typically required as most patients are asymptomatic. Congestive cardiac failure is managed with diuretics and atrial tachyarrhythmias with rate, rhythm, and anticoagulation therapy. 

Treatment options include percutaneous and surgical closure and indications for intervention include: 

• Dilatation of right chambers without pulmonary artery hypertension (PAH), regardless of symptoms
• Paradoxical embolism 
• PAH with marked left-to-right shunt (Qp:Qs>1.5)

A percutaneous approach is the first choice for secundum ASD with adequate margins from AV valves, coronary sinus, origin of vena cava and right pulmonary veins. Surgical repair has a low mortality and a good long-term outcome when performed early during childhood and in the absence of pulmonary hypertension. 

ASD closure is contraindicated in irreversible pulmonary hypertension (systolic pulmonary pressure > 2/3 systolic BP) and in Eisenmenger physiology. 

Pregnancy

Women with uncomplicated ASD can have uncomplicated pregnancies despite the physiological increase in stroke volume and cardiac output. Venous thromboembolism prophylaxis is important as there exists a risk of paradoxical embolisation. 

Antibiotic prophylaxis

The risk of infective endocarditis is higher in those with an ASD than in the general population but the European Society of Cardiology (ESC) guidelines recommend antibiotic prophylaxis in the following: 

• Cyanotic congenital heart disease 
• Previous infective endocarditis 
• Repaired defect with prosthetic material for the first 6 months 
• Residual defect after intervention