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ASD Closure — RACP Adult Medicine MCQ

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HardCardiologyASD ClosureRACP Adult Medicine

A 42-year-old with a secundum atrial septal defect has Qp:Qs 2.5:1, right-ventricular dilatation and pulmonary artery systolic pressure 35 mmHg without pulmonary vascular disease. What is the appropriate management?

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Correct answer: C — Refer for defect closure after anatomical assessment, using a transcatheter device when suitable

The best answer is “Refer for defect closure after anatomical assessment, using a transcatheter device when suitable”. A significant left-to-right shunt with right-sided volume overload is an indication for closure when pulmonary vascular resistance is acceptable. Secundum defects are often closed percutaneously if rims and anatomy permit. Mild pressure elevation is not Eisenmenger syndrome; medicines do not remove the volume load, and waiting risks arrhythmia and progressive right-heart dysfunction.

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