Treatment of Atrial Septal Defect in Left Ventricular Disease with Impaired LV Function

Clinical Scenario

This protocol applies to patients with an atrial septal defect (ASD) who also have underlying left ventricular disease — specifically impaired left ventricular function, encompassing both systolic and diastolic dysfunction.

Why This Comorbidity Changes Management

In patients with left ventricular disease, ASD closure carries specific risks. The potential benefit of eliminating the left-to-right shunt must be carefully weighed against the possibility that closure itself — by increasing filling pressure — may worsen heart failure symptoms and outcomes. Standard closure decisions do not apply here.

Approach (Partial Overview)

Management begins with pre-interventional haemodynamic assessment using balloon occlusion testing. The findings from this testing guide the decision between different closure strategies — the full structured protocol specifies what each result implies and how to proceed.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehaa554

In patients with LV disease, it is recommended to perform balloon testing and carefully weigh the benefit of eliminating LR shunt against the potential negative impact of ASD closure on outcome due to an increase in filling pressure (taking closure, fenestrated closure, and no closure into consideration).
In patients with impaired LV function (systolic and diastolic), ASD closure may worsen heart failure.
These patients must be carefully evaluated and may require pre-interventional testing (balloon occlusion with reassessment of haemodynamics) to decide between complete, fenestrated, or no closure, considering that an increase in filling pressure due to ASD closure may worsen symptoms and outcome.

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