Atrial septal defect ostium secundum overview

Revision as of 02:17, 15 March 2016 by WikiBot (talk | contribs) (Bot: Adding CME Category::Cardiology)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to navigation Jump to search

Atrial septal defect ostium secundum Microchapters

Home

Overview

Anatomy

Pathophysiology

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Chest X Ray

Electrocardiogram

Echocardiography

Other Diagnostic Studies

Treatment

Medical Therapy

Indications for Surgical Repair

Surgical Closure

Percutaneous Closure

Case Studies

Case #1

Atrial septal defect ostium secundum overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Atrial septal defect ostium secundum overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Atrial septal defect ostium secundum overview

CDC on Atrial septal defect ostium secundum overview

Atrial septal defect ostium secundum overview in the news

Blogs on Atrial septal defect ostium secundum overview

Directions to Hospitals Treating Atrial septal defect ostium secundum

Risk calculators and risk factors for Atrial septal defect ostium secundum overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Atrial septal defect ostium secundum are ASDs at the level of fossa ovalis. It accounts for 75% of all atrial septal defects.

Anatomy

During fetal development, the septal wall may fail to fuse causing an atrial septal defect to arise. An ostium secundum atrial septal defect is one such type of malformation arising from the irregular development of the foramen ovale, septum secundum or septum primum. It is the most common type of atrial septal defect.

Pathophysiology

Although atrial septal defect ostium secundum defects occur sporadically, they are associated with and occur with higher frequency in certain genetic disorders.

Epidemiology and Demographics

Ostium secundum atrial septal defects are the most common form of atrial septal defect. They constitute approximately 60%-75% of all the atrial septal defects and account for 6%-10% of all congenital heart defects.

Natural History, Complications and Prognosis

Most individuals with an uncorrected secundum ASD are asymptomic or experience minimal symptoms through early adulthood. About 70% of all ostium secundum ASD patients' develop symptoms by the time they are in their 40s. Symptom onset and severity is largely dependent upon the size of the defect. Without intervention prior to the development of Eisenmenger's syndrome, the mortality rate for symptomatic adults is greater than 50%. Possible complications include atrial fibrillation, pulmonary hypertension and stroke.

Diagnosis

Echocardiography

Echocardiography may be used as a diagnostic tool in the evaluation of an atrial septal defect. Common malformations of the septal wall include: ostium primum, ostium secundum, sinus venosus, and patent foramen ovale. Uncommonly, a defect may occur in the coronary sinus. Specific characteristics exist in echocardiography to identify these various classifications of atrial septal defects.

Treatment

Medical Therapy

Definitive treatment of atrial septal defect involves surgical closure of the defect. Medical therapy has a limited role in the management of ASD, and is often used to manage complications like arrhythmia, congestive heart failure and other comorbidities associated with atrial septal defects such as stroke and migraine.

Indications for Surgical Repair in Adults

The decision to surgically close an atrial septal defect depends upon many contributing factors including the type of defect, the size of defect, the amount of left-to-right shunting, the development or worsening of symptoms, the presence of pulmonary hypertension and the presence of any associated anomalies.

Surgical Closure

Surgical closure is the commonest treatment method for atrial septal defect and has been the gold standard for many years. Many surgeons prefer more minimally invasive techniques over the conventional sternotomy to avoid potentials for additional complications. Special consideration must be taken into account for the age of the patient and the size of the defect involved. Surgical closure is indicated for patients with primum, sinus venosus and coronary sinus type of atrial septal defects. However, ostium secundum atrial septal defects are commonly treated by percutaneous closure. With uncomplicated atrial septal defect, (without pulmonary hypertension and other comorbidities) the post-surgical mortality is as low as 1%.

Percutanous Closure

Percutaneous device closure is commonly performed to close an ostium secundum type of atrial septal defect and patent foramen ovales. It is still not FDA approved for closure of other forms of atrial septal defects such as primum, sinus venosus and coronary sinus. With proper patient selection at experienced centers, it has been found to be as successful, safe and effective as surgical closure. Additionally, it has been associated with fewer complications and a reduced length of stay compared to surgical closure. [1]

References

  1. Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K, Amplatzer Investigators (2002). "Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial". J Am Coll Cardiol. 39 (11): 1836–44. PMID 12039500.

Template:WH Template:WS CME Category::Cardiology