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Atrial Septal Defect — EECC MCQ

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HardCongenital Heart Disease (Adult)Atrial Septal DefectEECC

A 28-year-old woman with a large unrepaired secundum atrial septal defect is assessed. Echocardiography shows RV dilatation with Qp:Qs ratio of 2.2:1. Estimated RV systolic pressure is 42 mmHg. She is NYHA class II. She has no Eisenmenger syndrome. What is the recommended management?

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Correct answer: B — Percutaneous device closure of the ASD

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

Per the 2020 ESC ACHD Guidelines, closure is recommended for secundum ASDs with evidence of RV volume overload (Qp:Qs above 1.5:1 with RV dilatation) regardless of symptoms (Class I). Percutaneous device closure is the preferred method for suitable anatomy. Surgical closure (B) is reserved for unsuitable anatomy. Medical therapy alone (C) does not address volume overload. Pulmonary vasodilators (D) are not indicated with mildly elevated RVSP. Watchful waiting (E) risks progressive RV dysfunction.

Reference: ESC (2020): Guidelines for the Management of Adult Congenital Heart Disease