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

Atrial Septal Defect, Coronary Sinus: Follow-up

Author: Louis I Bezold, MD, Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine; Chief, Division of Pediatric Cardiology, Medical Director, Kentucky Children's Hospital
Contributor Information and Disclosures

Updated: Nov 14, 2008

Follow-up

Further Inpatient Care

  • Admit patients with coronary sinus atrial septal defects (ASDs) for the management of arrhythmias in selected cases and for surgical intervention.

Further Outpatient Care

  • Monitor for the development of symptoms associated with left-to-right shunt or arrhythmia.
  • Monitor for efficacy and for adverse effects of medications.

Inpatient & Outpatient Medications

  • Medications include diuretics, digoxin, and various antiarrhythmics.

Transfer

  • Transfer may be required for further diagnostic evaluation or surgical intervention.

Deterrence/Prevention

  • The use of birth control pills is not recommended with unrepaired ASDs because of increased risk of thrombosis and the risk of paradoxical emboli.
  • The pregnancy -related risk for unrepaired coronary sinus defects is not known but should be similar to that observed with secundum ASDs, given the physiologic similarities. The mortality rate for secundum ASDs in pregnancy is reported to be less than 1%, and the liveborn rate approaches the normal rate.
  • Pregnancy may cause patients to become more symptomatic in terms of exercise intolerance and congestive heart failure than they were before but is generally well tolerated, uncomplicated, and requires no special management. An exception is the patient with pulmonary vascular disease, as this condition poses a high risk to the expectant mother and often results in miscarriage. Potential complications include secondary pulmonary hypertension (which occur in a subset of patients), paradoxical embolism in the presence of deep vein thrombosis (which common during pregnancy because of stasis), and amniotic fluid embolus.

Complications

  • Congestive heart failure
  • Paradoxical emboli or stroke
  • Arrhythmia
  • Atrial fibrillation or flutter
  • Pulmonary hypertension

Prognosis

  • The prognosis is generally excellent for defects repaired in childhood or adolescence without associated pulmonary hypertension.
  • When associated with heterotaxy syndromes, the prognosis depends on the severity of associated lesions.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize signs and symptoms of atrial septal defect (ASD)
  • Failure to recognize associated structural heart disease or pulmonary hypertension
  • Failure to recommend and discuss appropriate treatment options
  • Failure to inform patient and family of activity restrictions
 


More on Atrial Septal Defect, Coronary Sinus

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

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Further Reading

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Keywords

coronary sinus atrial septal defect, coronary sinus ASD, unroofed coronary sinus, interatrial shunting, persistent left superior vena cava draining to the coronary sinus, LSVC, heterotaxy syndrome, abnormalities of atrial situs, anomalies of systemic venous return, venous emboli, paradoxical emboli, communication between the right and left atria, congenital heart disease, CHD, cardiovascular disease, heart disease, tricuspid atresia, pulmonary atresia, right ventricular hypertrophy, mitral stenosis, atrial hypertension, pulmonary vascular disease, mitral valve prolapse, mitral regurgitation, ostium secundum ASD, exercise intolerance, tachycardia, bacterial endocarditis, failure to thrive, reactive airway disease

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Contributor Information and Disclosures

Author

Louis I Bezold, MD, Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine; Chief, Division of Pediatric Cardiology, Medical Director, Kentucky Children's Hospital
Louis I Bezold, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Society of Echocardiography, and Society of Pediatric Echocardiography
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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