eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Atrial Septal Defect, Ostium Secundum: Follow-up

Author: Ira H Gessner, MD, Professor Emeritus, Pediatric Cardiology
Contributor Information and Disclosures

Updated: Nov 10, 2008

Follow-up

Further Inpatient Care

  • No further inpatient care is required in patients with ostium secundum atrial septal defect.

Further Outpatient Care

  • If the immediate postoperative echocardiography confirms complete closure, a follow-up visit one year following closure is adequate to evaluate possible long-term complications (rare). Patients who undergo closure of a large defect late in childhood (when >8 y) should be advised to continue infrequent cardiology evaluations with electrocardiographic studies approximately every 5 years to monitor for the possible occurrence of a dysrhythmia.27
  • Patients who undergo device closure of a secundum atrial septal defect should continue cardiology evaluations until long-term published studies establish the absence of late complications.

Inpatient & Outpatient Medications

  • No medications are required, except bacterial endocarditis prophylaxis for 6 months following either device or patch closure.

Transfer

  • Evaluation and treatment should be carried out at a center specializing in congenital heart disease.

Complications

  • Surgical damage to the sinoatrial node occurs rarely when experienced individuals accomplish closure. Short and long-term postoperative rhythm disturbances can occur, however, particularly when closure of a large defect is delayed beyond early childhood (ie, >8 y).
  • Late complications of device closure can include rhythm disturbance, perforation of the heart, fracture of the supporting structures of the device, and residual shunts. Long-term late complications remain unknown

Prognosis

  • The surgical mortality rate should be less than 0.1%. If defects are closed in children younger than 8 years, the prognosis is excellent, with rare short-term or long-term cardiac abnormalities.
  • Patients with incomplete closure or closure at older age remain at risk for development of cardiac rhythm disturbances. Whether closure of a secundum atrial septal defect in a person older than 40 years alters the patient's risk of either cardiac disability or limitation of life remains controversial.28

Patient Education

  • No patient restrictions are indicated. Families and patients should have some familiarity with symptoms of cardiac dysrhythmias.
  • Genetic counseling is advised for all patients and their families, especially if other family members are affected.
  • When a child with a secundum atrial septal defect reaches maturity education regarding the significance of the defect is advisable.

Miscellaneous

Medicolegal Pitfalls

  • Failure of the primary care physician to identify abnormal cardiac physical examination findings can create a problem.
  • Surgical or catheter mishaps may raise concerns, especially if the operator is inexperienced in treating congenital heart defects.

Special Concerns

  • Pregnancy does not involve an altered risk after successful closure of a secundum atrial septal defect, even with a persistent residual small shunt. Women with an unoperated and uncomplicated defect generally tolerate pregnancy well.
 


More on Atrial Septal Defect, Ostium Secundum

Overview: Atrial Septal Defect, Ostium Secundum
Differential Diagnoses & Workup: Atrial Septal Defect, Ostium Secundum
Treatment & Medication: Atrial Septal Defect, Ostium Secundum
Follow-up: Atrial Septal Defect, Ostium Secundum
References
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References

  1. Gessner IH. Atrial septal defect. In: Surgery of Congenital Heart Disease: Pediatric Care Consortium 1984-1995. Armonk, NY: Futura Publishing Co.; 1998:31-44.

  2. Vick GW, Titus JL. Defects of the atrial septum, including the atrioventricular canal. In: Garson A, Bricker JT, Fisher, DJ, Neish, SR eds. The Science and Practice of Pediatric Cardiology. Vol 2. Baltimore, MD: Lippincott Williams & Wilkins; 1998.

  3. Azhari N, Shihata MS, Al-Fatani A. Spontaneous closure of atrial septal defects within the oval fossa. Cardiol Young. Apr 2004;14(2):148-55. [Medline].

  4. Saxena A, Divekar A, Soni NR. Natural history of secundum atrial septal defect revisited in the era of transcatheter closure. Indian Heart J. Jan-Feb 2005;57(1):35-8. [Medline].

  5. Hanslik A, Pospisil U, Salzer-Muhar U, Greber-Platzer S, Male C. Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. Pediatrics. Oct 2006;118(4):1560-5. [Medline]. [Full Text].

  6. McMahon CJ, Feltes TF, Fraley JK, et al. Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart. Mar 2002;87(3):256-9. [Medline].

  7. Sachweh JS, Daebritz SH, Hermanns B, et al. Hypertensive pulmonary vascular disease in adults with secundum or sinus venosus atrial septal defect. Ann Thorac Surg. Jan 2006;81(1):207-13. [Medline].

  8. Caputo S, Capozzi G, Russo MG, et al. Familial recurrence of congenital heart disease in patients with ostium secundum atrial septal defect. Eur Heart J. Oct 2005;26(20):2179-84. [Medline].

  9. Sznajer Y, Keren B, Baumann C, et al. The spectrum of cardiac anomalies in Noonan syndrome as a result of mutations in the PTPN11 gene. Pediatrics. Jun 2007;119(6):e1325-31. [Medline]. [Full Text].

  10. Godwin KA, Sibbald B, Bedard T, Kuzeljevic B, Lowry RB, Arbour L. Changes in frequencies of select congenital anomalies since the onset of folic acid fortification in a Canadian birth defect registry. Can J Public Health. Jul-Aug 2008;99(4):271-5. [Medline].

  11. Wu ET, Akagi T, Taniguchi M, et al. Differences in right and left ventricular remodeling after transcatheter closure of atrial septal defect among adults. Catheter Cardiovasc Interv. May 1 2007;69(6):866-71. [Medline].

  12. Walker RE, Moran AM, Gauvreau K, Colan SD. Evidence of adverse ventricular interdependence in patients with atrial septal defects. Am J Cardiol. Jun 1 2004;93(11):1374-7, A6. [Medline].

  13. Giardini A, Donti A, Formigari R, et al. Determinants of cardiopulmonary functional improvement after transcatheter atrial septal defect closure in asymptomatic adults. J Am Coll Cardiol. May 19 2004;43(10):1886-91. [Medline].

  14. Arrington CB, Tani LY, Minich LL, Bradley DJ. An assessment of the electrocardiogram as a screening test for large atrial septal defects in children. J Electrocardiol. Nov-Dec 2007;40(6):484-8. [Medline].

  15. Brassard M, Fouron JC, van Doesburg NH, Mercier LA, De Guise P. Outcome of children with atrial septal defect considered too small for surgical closure. Am J Cardiol. Jun 1 1999;83(11):1552-5. [Medline].

  16. Doll N, Walther T, Falk V, et al. Secundum ASD closure using a right lateral minithoracotomy: five-year experience in 122 patients. Ann Thorac Surg. May 2003;75(5):1527-30; discussion 1530-1. [Medline].

  17. Argenziano M, Oz MC, Kohmoto T, et al. Totally endoscopic atrial septal defect repair with robotic assistance. Circulation. Sep 9 2003;108 Suppl 1:II191-4. [Medline]. [Full Text].

  18. Shah D, Azhar M, Oakley CM, et al. Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study. Br Heart J. Mar 1994;71(3):224-7; discussion 228. [Medline].

  19. Bolz D, Lacina T, Buser P, et al. Long-term outcome after surgical closure of atrial septal defect in childhood with extensive assessment including MRI measurement of the ventricles. Pediatr Cardiol. Sep-Oct 2005;26(5):614-21. [Medline].

  20. Lock JE, Cockerham JT, Keane JF, et al. Transcatheter umbrella closure of congenital heart defects. Circulation. Mar 1987;75(3):593-9. [Medline].

  21. Jones TK, Latson LA, Zahn E, et al. Results of the U.S. multicenter pivotal study of the HELEX septal occluder for percutaneous closure of secundum atrial septal defects. J Am Coll Cardiol. Jun 5 2007;49(22):2215-21. [Medline].

  22. Patel A, Lopez K, Banerjee A, Joseph A, Cao QL, Hijazi ZM. Transcatheter closure of atrial septal defects in adults > or =40 years of age: immediate and follow-up results. J Interv Cardiol. Feb 2007;20(1):82-8. [Medline].

  23. Post MC, Suttorp MJ, Jaarsma W, Plokker HW. Comparison of outcome and complications using different types of devices for percutaneous closure of a secundum atrial septal defect in adults: a single-center experience. Catheter Cardiovasc Interv. Mar 2006;67(3):438-43. [Medline].

  24. Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A. Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med. Nov 29 2007;357(22):2262-8. [Medline].

  25. Vida VL, Barnoya J, O'Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol. Jan 17 2006;47(2):326-31. [Medline].

  26. Butera G, Carminati M, Chessa M, et al. Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications. Am Heart J. Jan 2006;151(1):228-34. [Medline].

  27. Giardini A, Donti A, Specchia S, Formigari R, Oppido G, Picchio FM. Long-term impact of transcatheter atrial septal defect closure in adults on cardiac function and exercise capacity. Int J Cardiol. Feb 29 2008;124(2):179-82. [Medline].

  28. Brochu MC, Baril JF, Dore A, et al. Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation. Oct 1 2002;106(14):1821-6. [Medline]. [Full Text].

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Further Reading

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Keywords

ostium secundum atrial septal defect, ASD, fossa ovalis defect, secundum atrial septal defect, atrial dysrhythmia, right heart dysfunction, patent foramen ovale, chronic right atrial dilation, heart failure, atrial fibrillation, atrial flutter, atrial dysrhythmia, stroke, obstructive pulmonary vascular disease, failure to thrive, bacterial endocarditis, primary pulmonary hypertension, pulmonary valve stenosis, Holt-Oram syndrome

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Contributor Information and Disclosures

Author

Ira H Gessner, MD, Professor Emeritus, Pediatric Cardiology
Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Paul M Seib, MD, Associate Professor of Pediatrics, University of Arkansas for Medical Sciences; Medical Director, Cardiac Catheterization Laboratory, Co-Medical Director, Cardiovascular Intensive Care Unit, Arkansas Children's Hospital
Paul M Seib, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Arkansas Medical Society, International Society for Heart and Lung Transplantation, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Alvin J Chin, MD, Professor of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
Alvin J Chin, MD is a member of the following medical societies: American Association for the Advancement of Science and American Heart Association
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association
Disclosure: Nothing to disclose.

 
 
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