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Ostium Secundum Atrial Septal Defects Treatment & Management

  • Author: Ira H Gessner, MD; Chief Editor: P Syamasundar Rao, MD  more...
Updated: Jan 07, 2016

Medical Care

Small-to-moderate–sized ostium secundum atrial septal defects diagnosed in the infant demonstrate significant likelihood of either spontaneous closure or reduction in size to the point that medical intervention no longer is indicated. Such patients should be followed until age 3-4 years before considering either device use or surgical closure.[5, 19]

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


Patients should be evaluated by a pediatric cardiologist. Patients with defects considered appropriate for transcatheter device closure should be evaluated by an interventional pediatric cardiologist experienced in the procedure. If surgery is contemplated, the patient should be evaluated by a cardiovascular surgeon experienced in surgery of congenital heart defects. Ideally, decisions regarding therapy should result from simultaneous evaluation of patient data at a group meeting that includes all of these physicians.


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

Diet and activity

No special diet is required.

No activity restrictions are required except for a few weeks following either device closure or heart surgery.


Surgical Care

Minimally invasive cardiac surgery

Minimally invasive cardiac surgery techniques allow closure without the use of blood or blood products in appropriately sized patients.[20, 21, 22]

The skin incision is short because complete vertical division of the sternum is not necessary.

If the defect is moderate in size and oval in shape, direct suture closure may be appropriate. Larger or rounder defects require patch closure. The patch can be fashioned from the patient's pericardium or made from Dacron.

Results of surgery are excellent; a 100% closure rate should be achieved. Risk of mortality does not exceed that of general anesthesia.[23, 24]

Inpatient hospital stay averages 2-3 days. Perform postoperative echocardiography to confirm closure.

Postoperative care includes bacterial endocarditis precautions for 6 months if a patch was placed.

Cardiac catheter intervention

Catheter intervention may be indicated.

Transcatheter device closure of secundum atrial septal defect now represents a standard of care for this abnormality.[25] Experience at centers throughout the world is extensive; the success rate has been high, and the risk of complications has been low.[26, 27, 28, 29, 30, 31, 32, 33] Indication for closure in the pediatric age range is a shunt of sufficient size to be clinically apparent. The reason for closure is to prevent development of complications (eg, atrial dysrhythmia, right heart dysfunction) that may appear in the adult. Small defects in children that are detectable only by echocardiography do not require closure.

In adult patients who experience a suspected thrombotic stroke and who manifest a patent foramen ovale (15-20% of all adults demonstrate a patent foramen ovale on echocardiography), concern arises that the stroke may have been caused by a paradoxical embolus.[34] In these patients, device closure of the communication is often recommended and accomplished. Studies remain controversial regarding the appropriateness of this treatment.

Transcatheter device occlusion of a secundum atrial septal defect should be accomplished only by physicians properly trained and experienced in the procedure. Proper sizing of the defect and anatomic evaluation to assure reliable seating of the device is essential.

The device is placed in the atrial septum via a catheter introduced into a femoral vein. Most operators advise monitoring the procedure with transesophageal echocardiography. Multiple studies indicate a high degree of success, with complete closure rates only slightly less than those obtained by surgery.

Studies comparing device closure with surgery establish that hospital stay is shorter in patients undergoing device closure. Total costs of the 2 techniques do not significantly differ, apparently because of the cost of the device.[35]

Complications of device occlusion include hemorrhage, vascular disruption, pain, nausea and vomiting, and arterial or venous obstruction from thrombosis or spasm. Other complications include rupture of blood vessel, tachyarrhythmias, bradyarrhythmias, and vascular occlusion. Embolization of the device during placement rarely occurs but can result in emergency surgery for removal. The most common complication is incomplete closure of the defect.[36]

Contributor Information and Disclosures

Ira H Gessner, MD Professor Emeritus, Pediatric Cardiology, University of Florida College of Medicine

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, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alvin J Chin, MD Emeritus Professor of Pediatrics, 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, Society for Developmental Biology, American Heart Association

Disclosure: Nothing to disclose.

Chief Editor

P Syamasundar Rao, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

P Syamasundar Rao, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

  1. Gessner IH. Atrial septal defect. 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. Garson A, Bricker JT, Fisher, DJ, Neish, SR eds. The Science and Practice of Pediatric Cardiology. Baltimore, MD: Lippincott Williams & Wilkins; 1998. Vol 2:

  3. Azhari N, Shihata MS, Al-Fatani A. Spontaneous closure of atrial septal defects within the oval fossa. Cardiol Young. 2004 Apr. 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. 2005 Jan-Feb. 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. 2006 Oct. 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. 2002 Mar. 87(3):256-9. [Medline].

  7. Scheuerle A. Clinical differentiation of patent foramen ovale and secundum atrial septal defect: a survey of pediatric cardiologists in Dallas, Texas, USA. J Registry Manag. 2011 Spring. 38(1):4-8. [Medline].

  8. 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. 2006 Jan. 81(1):207-13. [Medline].

  9. Siddiqui WT, Parveen S, Siddiqui MT, Amanullah MM. Clinical outcomes of surgically corrected atrial septal defects. J Pak Med Assoc. 2013 May. 63(5):662-5. [Medline].

  10. 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. 2002 Oct 1. 106(14):1821-6. [Medline]. [Full Text].

  11. 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. 2005 Oct. 26(20):2179-84. [Medline].

  12. 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. 2007 Jun. 119(6):e1325-31. [Medline]. [Full Text].

  13. 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. 2008 Jul-Aug. 99(4):271-5. [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. 2007 Nov-Dec. 40(6):484-8. [Medline].

  15. 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. 2007 May 1. 69(6):866-71. [Medline].

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

  17. 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. 2004 May 19. 43(10):1886-91. [Medline].

  18. Rigatelli G, Dell' Avvocata F, Cardaioli P, Giordan M, Vassiliev D, Nghia NT, et al. Five-year Follow-up of Intracardiac Echocardiography-assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect. Congenit Heart Dis. 2011 Oct 20. [Medline].

  19. 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. 1999 Jun 1. 83(11):1552-5. [Medline].

  20. 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. 2003 May. 75(5):1527-30; discussion 1530-1. [Medline].

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

  22. Atashband A, Lakkis N. First Comprehensive Analysis of Outcomes in Adult Patients after Percutaneous Closure of Isolated Secundum Atrial Septal Defects. Cardiovasc Hematol Agents Med Chem. 2015. 13 (1):63-9. [Medline].

  23. 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. 1994 Mar. 71(3):224-7; discussion 228. [Medline].

  24. 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. 2005 Sep-Oct. 26(5):614-21. [Medline].

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

  26. 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. 2007 Jun 5. 49(22):2215-21. [Medline].

  27. 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. 2007 Feb. 20(1):82-8. [Medline].

  28. 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. 2006 Mar. 67(3):438-43. [Medline].

  29. Shimizu S, Kawamura A, Arai T, Ohno Y, Mogi S, Kodaira M, et al. Intracardiac echocardiography for percutaneous closure of atrial septal defects: initial experiences in Japan. Cardiovasc Interv Ther. 2013 May 26. [Medline].

  30. Stroker E, Van De Bruaene A, De Meester P, Van Deyck K, Gewillig M, Budts W. Transcatheter device closure of atrial septal defects in patients above age 60. Acta Cardiol. 2013 Apr. 68(2):127-32. [Medline].

  31. Kazmouz S, Kenny D, Cao QL, Kavinsky CJ, Hijazi ZM. Transcatheter closure of secundum atrial septal defects. J Invasive Cardiol. 2013 May. 25(5):257-64. [Medline].

  32. Taniguchi M, Akagi T, Kijima Y, Sano S. Clinical advantage of real-time three-dimensional transesophageal echocardiography for transcatheter closure of multiple atrial septal defects. Int J Cardiovasc Imaging. 2013 Apr 23. [Medline].

  33. Chen TH, Hsiao YC, Cheng CC, et al. In-Hospital and 4-Year Clinical Outcomes Following Transcatheter Versus Surgical Closure for Secundum Atrial Septal Defect in Adults: A National Cohort Propensity Score Analysis. Medicine (Baltimore). 2015 Sep. 94 (38):e1524. [Medline]. [Full Text].

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

  35. 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. 2006 Jan 17. 47(2):326-31. [Medline].

  36. 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. 2006 Jan. 151(1):228-34. [Medline].

  37. 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. 2008 Feb 29. 124(2):179-82. [Medline].

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