Management of Adults With Congenital Heart Disease
Publication Date: August 16, 2018
Last Updated: December 15, 2022
Treatment
3.2. Access to Care
a) assuring smooth transitions for adolescents and young adults from pediatric to adult providers; and
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b) promoting awareness of the need for lifelong specialized care through outreach and educational programs.
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4. Specific Lesions
4.1.1. Atrial Septal Defect
Diagnostic
- Pulse oximetry at rest and during exercise is recommended for evaluation of adults with unrepaired or repaired ASD with residual shunt to determine the direction and magnitude of the shunt.
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- CMR, CCT, and/or TEE are useful to evaluate pulmonary venous connections in adults with ASD.
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- Echocardiographic imaging is recommended to guide percutaneous ASD closure.
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Therapeutic
- In adults with isolated secundum ASD causing impaired functional capacity, right atrial and/or RV enlargement, and net left-to-right shunt sufficiently large to cause physiological sequelae (e.g., pulmonary–systemic blood flow ratio [Qp:Qs] ≥1.5:1) without cyanosis at rest or during exercise, transcatheter or surgical closure to reduce RV volume and improve exercise tolerance is recommended, provided that systolic PA pressure is less than 50% of systolic systemic pressure and pulmonary vascular resistance is less than one third of the systemic vascular resistance.
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- Adults with primum ASD, sinus venosus defect or coronary sinus defect causing impaired functional capacity, right atrial and/or RV enlargement and net left-to-right shunt sufficiently large to cause physiological sequelae (e.g., Qp:Qs ≥1.5:1) without cyanosis at rest or during exercise, should be surgically repaired unless precluded by comorbidities, provided that systolic PA pressure is less than 50% of systemic pressure and pulmonary vascular resistance is less than one third of the systemic vascular resistance.
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- In asymptomatic adults with isolated secundum ASD, right atrial and RV enlargement, and net left-to-right shunt sufficiently large to cause physiological sequelae (e.g., Qp:Qs 1.5:1 or greater), without cyanosis at rest or during exercise, transcatheter or surgical closure is reasonable to reduce RV volume and/or improve functional capacity, provided that systolic PA pressure is less than 50% of systemic pressure and pulmonary vascular resistance is less than one third systemic resistance.
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- Surgical closure of a secundum ASD in adults is reasonable when a concomitant surgical procedure is being performed and there is a net left-to-right shunt sufficiently large to cause physiological sequelae (e.g., Qp:Qs 1.5:1 or greater) and right atrial and RV enlargement without cyanosis at rest or during exercise.
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- Percutaneous or surgical closure may be considered for adults with ASD when net left-to-right shunt (Qp:Qs) is 1.5:1 or greater, PA systolic pressure is 50% or more of systemic arterial systolic pressure, and/or pulmonary vascular resistance is greater than one third of the systemic resistance.
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- ASD closure should not be performed in adults with PA systolic pressure greater than two thirds systemic, pulmonary vascular resistance greater than two thirds systemic, and/or a net right-to-left shunt.
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Overview
Title
Management of Adults With Congenital Heart Disease
Authoring Organizations
American College of Cardiology
American Heart Association