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

Atrial Septal Defect with Right Ventricular Volume Overload: Management When There Is No Pulmonary Arterial Hypertension

This protocol addresses the management of atrial septal defect (ASD) in patients who have evidence of right ventricular (RV) volume overload — characterised by RV enlargement with increased stroke volume — in the absence of pulmonary arterial hypertension (PAH) and without left ventricular (LV) disease.

Clinical Scenario

The patient presents with ASD causing RV volume overload — specifically RV enlargement with increased stroke volume. There are no non-invasive signs of pulmonary arterial pressure (PAP) elevation, and where investigated invasively, pulmonary vascular resistance (PVR) is confirmed below 3 Wood units. No left ventricular disease is present.

RV volume overload RV enlargement Increased stroke volume No PAH No LV disease

Treatment Direction

In this clinical situation, ASD closure is recommended regardless of symptoms. The preferred method — when anatomically suitable — is a catheter-based approach; a surgical alternative exists for patients in whom the preferred approach is not feasible.

The full structured regimen — including patient selection criteria, procedural considerations, and management of the elderly patient — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehaa554

In patients with evidence of RV volume overload and no PAH (no non-invasive signs of PAP elevation or invasive confirmation of PVR <3 WU in case of such signs) or LV disease, ASD closure is recommended regardless of symptoms.

Device closure is recommended as the method of choice for secundum ASD closure when technically suitable.

In elderly patients not suitable for device closure, it is recommended to carefully weigh the surgical risk against the potential benefit of ASD closure.

RV enlargement with increased stroke volume.

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