Atrial septal defect (ASD) is a common congenital heart condition characterized by a hole in the atrial septum allowing left-to-right shunting of blood. While many ASDs cause minimal symptoms, larger defects progress to right ventricular dilatation and eventual heart failure. Livasa Hospital offers both minimally invasive catheter-based and surgical ASD closure depending on anatomical suitability and patient factors.

Understanding Atrial Septal Defects

The atrial septum is the wall separating the right and left atria. Several types exist based on location:

• Ostium secundum ASD – Most common (70%); in the mid-septum near the fossa ovalis

• Ostium primum ASD – Near the AV valves; associated with valve abnormalities

• Sinus venosus ASD – Near the vena cava; often associated with partial anomalous pulmonary venous connection

• Unroofed coronary sinus ASD – Rare; communication between sinus and left atrium

Haemodynamic Effects

Left-to-right shunting increases pulmonary blood flow:

• Mild shunting – Minimal haemodynamic consequence

• Moderate-to-large shunts – Progressive right ventricular dilatation

• Chronic volume overload – Eventually leads to right ventricular dysfunction and failure

Importantly, ASDs can remain relatively asymptomatic until adulthood when progressive complications develop.

Clinical Presentation

Many ASDs are asymptomatic and discovered incidentally. When symptomatic:

• Dyspnoea – Especially with exertion

• Fatigue – Reduced exercise capacity

• Palpitations – Often atrial fibrillation

• Right heart failure – In advanced disease

Diagnostic Evaluation

Diagnosis and assessment includes:

• Clinical examination – Fixed S2 split; systolic murmur at pulmonary area

• Chest X-ray – Cardiomegaly with pulmonary overcirculation

• ECG – Right axis deviation; right ventricular hypertrophy

• Transthoracic echocardiography – Initial imaging; shows defect and flow

• Transoesophageal echocardiography – Superior detail for anatomical assessment

• Cardiac CT or MRI – Optional; for complex anatomy delineation

Management Indications

ASD closure is recommended for:

• Large ASDs – Qp:Qs ratio >1.5:1 (shunt ratio >50%)

• Progressive right ventricular dilatation – Even without symptoms

• Paradoxical embolism – History of stroke despite ASD closure

• Atrial fibrillation – Associated with significant shunt

• Right ventricular dysfunction – With significant shunt

Small ASDs with minimal shunting are often observed without intervention.

Catheter-Based ASD Closure

Minimally invasive transcatheter closure is preferred for suitable anatomy:

Procedure:

1. Femoral vein puncture and catheter advancement to right atrium

2. Transoesophageal echocardiographic guidance

3. Device positioning across the defect

4. Confirmation of position and occlusion

5. Device release and verification

Advantages:

• Minimally invasive; small incision only

• No cardiopulmonary bypass required

• Rapid recovery; same-day or next-day discharge

• Excellent success rates (>95%)

• No scar tissue

Limitations:

• Requires adequate defect anatomy

• Not suitable for all ASD types

• Device not available for complex defects

Surgical ASD Closure

Open surgical closure is necessary when:

• Anatomy unsuitable for catheter closure

• Associated lesions requiring surgical correction

• Failed catheter closure

Procedure:

• Median sternotomy and cardiopulmonary bypass

• Right atrial opening

• Primary closure or patch closure

• Inspection of other cardiac structures

Post-Closure Management

Immediate:

• Observation and monitoring

• Echocardiographic confirmation of closure

• Activity restrictions for 1 month

Long-term:

• Endocarditis prophylaxis (limited cases)

• Regular echocardiographic surveillance

• Activity recommendations

• Monitoring for arrhythmias

Expected Outcomes

• Excellent procedural success (>95% for catheter closure)

• Significant improvement in symptoms

• Prevention of progressive right ventricular dysfunction

• Normalisation of life expectancy

• Reduced risk of atrial fibrillation

Why Choose Livasa Hospital?

• Experienced interventional cardiologists for catheter closure

• Skilled cardiac surgeons for surgical cases

• Comprehensive transoesophageal echocardiographic assessment

• Access to multiple device types

• Integrated follow-up surveillance programs

NAP – Contact Details

Livasa Hospital Mohali
Sector 71, Sahibzada Ajit Singh Nagar (SAS Nagar)
Mohali, Punjab – 160071
Phone: +91-80788 80788 (24/7 Emergency)
Website: www.livasahospitals.com

Call +91-80788 80788 to discuss ASD closure options at Livasa Hospital.