Surgical and Interventional Approaches for Atrial Septal Defects

Atrial septal defects (ASDs) encompass a spectrum of interatrial communications that permit left-to-right shunting, leading to right heart volume overload and eventual pulmonary vascular changes. Conventional surgical repair, typically via median sternotomy and cardiopulmonary bypass, employs direct closure or patch techniques using autologous pericardium or synthetic materials. Variants of sinus venosus defects often require additional manoeuvres such as single- or double-patch reconstruction or the Warden procedure to redirect anomalous pulmonary venous return and preserve caval flow. Minimally invasive and robotic-assisted approaches have emerged, offering reduced operative trauma and expedited recovery while maintaining comparable safety and efficacy. Parallel to surgical advances, percutaneous device closure has become the preferred treatment for secundum ASDs in suitable anatomy, utilising self-expanding occluders delivered via catheterisation. More complex defects, notably superior sinus venosus ASDs with partial anomalous pulmonary venous connection, have prompted development of covered stent correction protocols that obviate open surgery in selected patients. Preprocedural imaging, increasingly enriched by three-dimensional echocardiography, cardiac magnetic resonance and virtual reality platforms, enhances anatomical delineation and planning. Post-repair surveillance recognises the potential for baffle obstruction or residual shunting, which may be addressed through transcatheter angioplasty and stenting. Long-term follow-up consistently demonstrates excellent survival but underscores the persistent risk of arrhythmias and right heart dysfunction, informing strategies for timely intervention and lifelong monitoring.

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Surgical and Interventional Approaches for Atrial Septal Defects publication trend

The graph below shows the total number of articles in surgical and interventional approaches for atrial septal defects across all publications each year (not limited to Nature Index journals).

Technical terms

Atrial septal defect (ASD): A congenital opening in the atrial septum permitting interatrial blood flow and right heart volume overload.

Sinus venosus atrial septal defect: A form of ASD located near the entry of the superior or inferior vena cava, often associated with anomalous pulmonary venous connections.

Transcatheter closure: A percutaneous technique that delivers an occlusion device across a defect under imaging guidance, avoiding open surgery.

Covered stent correction: Endovascular placement of a membrane-lined stent to close a sinus venosus defect and redirect pulmonary venous return without open surgical repair.

Pericardial baffle: A surgically constructed conduit using pericardium to reroute anomalous pulmonary veins through a defect into the left atrium.

References

1. Virtual Reality for Preprocedure Planning of Covered Stent Correction of Superior Sinus Venosus Atrial Septal Defects. Circulation Cardiovascular Interventions (2024).
2. Transcatheter management of obstructed baffle repairs of partial anomalous pulmonary veins: a case series. European Heart Journal - Case Reports (2024).
3. Long-term outcome after surgical correction of sinus venosus defect in a nationwide register-based cohort study. International Journal of Cardiology (2023).