Secundum ASD — RACP Adult Medicine MCQ
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Correct answer: A — Do not close the defect routinely; refer to an adult-congenital and pulmonary-hypertension centre for targeted management
The best answer is “Do not close the defect routinely; refer to an adult-congenital and pulmonary-hypertension centre for targeted management”. Established Eisenmenger physiology means the shunt serves as a pressure-relief pathway; closure can precipitate right-heart failure and is generally contraindicated. Specialist assessment addresses PAH therapy, oxygen where indicated, iron deficiency, pregnancy avoidance and transplant options. Decisions about anticoagulation are individual because both thrombosis and bleeding risks are increased.
Reference: CSANZ: Adult congenital heart disease standards of care: https://www.csanz.edu.au/Common/Uploaded%20files/Smart%20Suite/Smart%20Library/ddf3748f-2158-461c-a448-9e80c579f74f/ACHD_%20Recommendation%20Standards%20of%20Care%2811Mar2016%29.pdf Lung Foundation Australia: Pulmonary arterial hypertension: https://lungfoundation.com.au/support-resources/resource-hub/pulmonary-arterial-hypertension-fact-sheet/