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Atrial septal defect

Course on congenital heart disease in adult - Organised by the ESC Working Group on Grown-up Congenital Heart Disease and the Association for European Paediatric Cardiology (EAPC)

Congenital Heart Disease and Pediatric Cardiology

We had very good teaching session giving an overview of the morphology of inter-atrial communications (talk given by Monique Jongbloed, Abcoude, NL), echocardiography assessment (Kuberan Pushparajah, London, UK), echocardiography guidance for transcatheter closure and follow up after transcatheter and surgical intervention, presented by Jan Marek, London, UK.
From the morphology and echocardiographic diagnostic point of view, we learnt that inter-atrial communications include not only fossa ovalis defects (which make up 75% of inter-atrial communications), but also other communications, such as superior sinus venosus, coronary sinus defects and partial anomalous pulmonary venous drainage may present clinically similarly atrial septal defect (ASD).
Echocardiographic assessment currently involves several modalities used for catheter guidance with transoesophageal echocardiography (TOE) as a gold standard, although both 3D and intra-cardiac echocardiography (ICE) have several advantages, such as en-face views (3DE) with direct live navigation or no need for TOE (ICE) in high risk patients (oesophageal varices, tracheo-oesophageal abnormalities).
Post-procedural complications were discussed, and concerns were raised related to the increased risk of late erosion/perforation in fossa ovalis ASD with deficient antero-superior rims. Post-surgical complications caused by inappropriate closure of ASD in cases with postero-inferior defect and hyperplastic Eustachian valve and superior vena cava obstruction following Warden operation in superior sinus venosus defect with partial anomalous pulmonary venous connection were demonstrated (16% of all inter-atrial communications).




Atrial septal defect

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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