How would you manage an uncomplicated atrial septal defect ?
Early childhood
If the defect is detected in early childhood, surgical closure is recommended between the ages of 5 and 10 years to prevent the late onset of either right ven-tricular failure, atrial arrhythmias or right heart failure.
In adults
• Small ASDs can be left alone, although many believe that all ASDs must be closed. Those operated on before the age of 25 years have an excellent prognosis and one may anticipate normal long-term survival, but older patients require regular supervision. In a recent study, surgical repair of atrial septal defects in middle-aged and elderly patients was found to improve longevity and reduce functional limitation due to heart failure, and is therefore superior to medical treatment. However, the risk of atrial arrhythmias, especially fibrillation and flutter, and the attendant risk of thromboembolic events was not reduced by closure of the defect.
• Left-to-right shunt saturations of 1.5:1 or more require surgical closure to prevent right ventricular dysfunction.
• Closure in adults results in a reduction in right ventricular size and improves symptoms.
More recently, ASDs are being occluded by transcatheter button or 'clam-shell devices'.
Lexo edhe:
Early childhood
If the defect is detected in early childhood, surgical closure is recommended between the ages of 5 and 10 years to prevent the late onset of either right ven-tricular failure, atrial arrhythmias or right heart failure.
In adults
• Small ASDs can be left alone, although many believe that all ASDs must be closed. Those operated on before the age of 25 years have an excellent prognosis and one may anticipate normal long-term survival, but older patients require regular supervision. In a recent study, surgical repair of atrial septal defects in middle-aged and elderly patients was found to improve longevity and reduce functional limitation due to heart failure, and is therefore superior to medical treatment. However, the risk of atrial arrhythmias, especially fibrillation and flutter, and the attendant risk of thromboembolic events was not reduced by closure of the defect.
• Left-to-right shunt saturations of 1.5:1 or more require surgical closure to prevent right ventricular dysfunction.
• Closure in adults results in a reduction in right ventricular size and improves symptoms.
More recently, ASDs are being occluded by transcatheter button or 'clam-shell devices'.
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Lexo edhe: