Echocardiographic assessment of secundum-type atrial septal defects in the adult: role in treatment decisions.

The purpose of this study is to evaluate morphologic patterns of ostium secundum-type atrial septal defects (osASD) in the adult, analyzing their role in treatment decisions. The population was composed of 155 adults (age 43.3 +/- 18.9 years) consecutively diagnosed with osASD in our center, and confirmed by transthoracic and transesophageal echocardiography, between January 2000 and December 2007. Of these, 83 (53.5%) underwent successful percutaneous closure. Surgical closure was used in 31 patients (20.0%). The remaining 42 patients (27.1%) received conservative medical treatment. The mean diameter of the defects was 15.8 +/- 8.5 mm. The prevalence of mitral valve prolapse and severe pulmonary hypertension was also assessed. Based on the criteria in the literature, we detected 14 different morphologic patterns of osASD. There was a central defect in 45/155; 40/155 had a short rim and 20/155 two short rims, 24/155 were multifenestrated and 15/155 PFO-like, and 12/155 had three or more short rims. The different morphologic patterns in each treatment arm, as well as the criteria leading to their inclusion in each, are described. While percutaneously closed defects had a simpler morphology, those that were surgically closed were normally larger and had a more complex shape (with two or more deficient rims or multifenestrated, and thus not suitable for percutaneous closure).