Secundum ASD Percutaneous Closure — EECC MCQ

Correct answer: A — Percutaneous device closure is preferred for secundum ASD — success rates >95% with low complication rates; suitability depends on adequate rims around the defect for device anchoring (assessed by TOE); surgical closure is reserved for unsuitable anatomy or associated lesions

Secundum ASD closure per the 2020 ESC ACHD Guidelines: Indications for closure: (1) significant shunt (Qp:Qs >1.5:1) with RV volume overload (RA/RV dilatation); (2) paradoxical embolism; (3) symptoms. Method: (1) percutaneous device closure (Amplatzer, GORE) is first-line for secundum ASDs with: adequate rims (≥5 mm from the defect edge to surrounding structures — IVC, SVC, coronary sinus, AV valves, pulmonary veins), sufficient total septal length, and defect size typically ≤38 mm; (2) surgical closure is reserved for: deficient rims (particularly anterosuperior rim deficiency), very large defects, associated anomalous pulmonary venous drainage, other cardiac lesions requiring concomitant surgery, or after failed device attempt. This patient's Qp:Qs 2.5:1 with RV dilatation and normal PA pressures clearly meets closure criteria. Post-closure: aspirin for 6 months, endocarditis prophylaxis NOT required (unless residual shunt).

Reference: ESC (2020): ACHD Guidelines