Device Closure of ASD - Review

A few  points regarding ASD (a lot to remember, but worth knowing for the exam!)

Indications for closure of ASD

• Right heart (atrial and ventricular) enlargement due to ASD
• ASD minimum diameter > 10mm
• QP:QS > 1.5

Contraindications to device closure

• Multiple defects
• Clinically insignificant shunt (shunt ratio <0.7)
• Defects close to mitral/tricuspid valve

Benefits of closure of ASD

• Improved symptoms - lesser breathlessness
• Prevention of right heart failure and pulmonary hypertension

Problems with device closure

• Tachy or bradyarrhythmias
• High risk of stroke in elderly patients
• Small or large residual ASDs
• Device migration / erosion - rare