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ASD Closure — RACP Adult Medicine MCQ

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ModerateCardiologyASD ClosureRACP Adult Medicine

A 42-year-old woman presents with progressive exertional dyspnoea. Echocardiography shows a large secundum atrial septal defect with a Qp:Qs ratio of 2.5:1, right ventricular dilation, and estimated PASP of 35 mmHg. She has no Eisenmenger syndrome. What is the recommended management?

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Correct answer: B — Percutaneous device closure

A haemodynamically significant secundum ASD (Qp:Qs >1.5:1) with right ventricular volume overload should be closed to prevent progressive right heart failure, atrial arrhythmias, and paradoxical embolism. Percutaneous device closure (Amplatzer or similar occluder) is the preferred method for secundum ASDs with adequate rims. Surgical closure is reserved for large defects with inadequate rims for device closure, or for primum/sinus venosus ASDs. Once Eisenmenger physiology develops (fixed pulmonary vascular resistance with right-to-left shunting), closure is CONTRAINDICATED.

Reference: eTG – 2025 – Cardiovascular; ESC – 2020 – Adult Congenital Heart Disease Guidelines