Percutaneous ASD / PFO Closure

Atrial septal defect (ASD) is the second most common congenital heart disease in adults, accounting for approximately 10% of all congenital heart lesions. Isolated ASD results from abnormal development of the septa that partition the common atrium of the developing heart into right and left chambers. 70% of ASDs are of the ostium secundum variety. The incidence of ASD is approximately 3 per 10,000 live births. For the remainder of this article ASD will refer to isolated ostium secundum ASD unless otherwise specified.

Surgical correction is the standard of care for other types of ASD such as ostium primum and sinus venosus ASD. The surgical approach was once the standard of care for secundum ASD, proving to be both safe and effective. It remains as such in many developing countries. However, over the past few decades many devices have been developed to treat secundum ASD percutaneously. Currently two such devices are approved by the FDA in USA: The Amplatzer Septal Occluder (ASO) and the Helex closure device. The benefit of the percutaneous approach has been well-demonstrated in the pediatric population. The purpose of this review is to illustrate the safety and efficacy of percutaneous device closure of secundum ASD in the adult population. Following percutaneous closure of ASD, adults of all ages experience improved symptoms, reduction in pulmonary artery (PA) pressure and reverse remodeling of the right ventricle (RV). It appears that these effects are more pronounced when the defect is closed earlier, rather than later. The transcatheter approach is evolving to become the new standard of care for adults with ASD. ASD closure should be considered in all hemodynamically significant secundum ASDs regardless of the patient’s age or symptoms.