28
Specific Conditions
4.1.1. Atrial Septal Defect
COR LOE
Recommendations
Diagnostic
1 B-NR
1. In adults with an unrepaired ASD, CMR imaging,
transesophageal echocardiography, or cardiac CT is
recommended to define defect size, morpholog y, rim
anatomy, and pulmonary venous connections.
1 B-NR
2. Adults with an unrepaired ASD and PAH should undergo
risk assessment and management in consultation with
pulmonary hypertension specialists to improve outcomes.
1 C-EO
3. Adults with an unrepaired ASD should be assessed for the
presence of PAH to guide medical therapy and determine
suitability for repair.
2b C-LD
4. In adults with an unrepaired ASD, balloon test occlusion before
closure may be reasonable to assess hemodynamic changes.
erapeutic
1 B-R
5. In adults with an unrepaired ASD, significant left-to-right
shunt (Qp:Qs ≥ 1.5) and right ventricular (RV) dilation, in
the absence of PAH (PVR ≤2 Wood units) or significant LV
disease*, ASD closure is recommended to improve functional
class and clinical outcomes.
1 B-NR
6. In adults with an isolated unrepaired secundum ASD,
transcatheter closure is usually preferred to surgical repair to
reduce length of stay and recovery time.
1 C-EO
7. In adults with an unrepaired ASD and evidence of (or
strong suspicion for) paradoxical embolism, ASD closure is
recommended to prevent recurrent embolism.
2a B-R
8. In adults with an unrepaired ASD, significant left-to-right
shunt (Qp:Qs ≥1.5) and RV dilation, with a PVR >2 to
<5 Wood units, and without significant LV disease,* ASD
closure is reasonable to improve functional status.
2a B-NR
9. In adults with an unrepaired ASD, significant left-to-right
shunt (Qp:Qs ≥1.5), RV dilation, PAH (PVR 5 to 8 Wood
units), and without significant LV disease, closure can be
beneficial if PVR <5 Wood units can be achieved with targeted
PAH therapy, to improve medium-term functional status.
