Atrial septal defect
ICD-10 Q21.1 · ICD-11 LA8E.Y

Atrial Septal Defect with Pulmonary Arterial Hypertension or Eisenmenger Physiology

Management of atrial septal defect (ASD) requires a distinct approach when the patient presents with advanced pulmonary vascular disease or significant haemodynamic compromise. This protocol addresses that specific clinical situation.

Clinical Scenario

This protocol applies when any of the following criteria are met:

  • Eisenmenger physiology
  • Pulmonary arterial hypertension (PAH) PAH with pulmonary vascular resistance (PVR) ≥5 Wood Units despite targeted PAH treatment
  • Desaturation on exercise — arterial oxygen saturation falling below 90%

In each of these presentations, the standard approach to ASD management does not apply. The full protocol specifies the evidence-based course of action for this sub-population.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehaa554

ASD closure is not recommended in patients with Eisenmenger physiology, patients with PAH and PVR ≥5 WU despite targeted PAH treatment, or desaturation on exercise.

There are limited data available for a precise cut-off, but by clinical experience, this would be given by a fall of arterial oxygen saturation <90%.

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