Browse the corpus

Transcatheter closure of atrial septal defects (ASDs) is a minimally invasive, catheter-based intervention to eliminate abnormal left-to-right interatrial shunting. The procedure is an alternative to surgical repair in appropriately selected patients, reducing morbidity and facilitating faster recovery. Comprehensive preprocedural evaluation includes transthoracic or transesophageal echocardiography and cardiac catheterization to assess defect size, rim adequacy, and pulmonary hemodynamics. Under fluoroscopic and echocardiographic guidance, an occluder device is delivered through femoral venous access and deployed across the septal defect to achieve complete closure. Intra- and periprocedural management requires meticulous attention to anticoagulation, arrhythmia surveillance, and device stability. Postprocedural care involves antiplatelet therapy, echocardiographic follow-up, and prophylaxis for infective endocarditis. When performed in specialized centers, transcatheter ASD closure achieves high success rates and excellent long-term outcomes. Through this educational activity, the learner develops advanced competence in patient selection, imaging interpretation, device sizing, and intraprocedural management for transcatheter ASD closure. The curriculum emphasizes collaboration among clinicians, interventional cardiologists, echocardiographers, anesthesiologists, and catheterization laboratory staff to ensure procedural precision and patient safety. Interprofessional teamwork enhances communication, streamlines decision-making, and reduces complication risk. By integrating evidence-based practices within a coordinated multidisciplinary framework, participants strengthen procedural confidence, optimize postprocedural outcomes, and contribute to safe, patient-centered cardiovascular care. Objectives: Identify patients with atrial septal defects who are appropriate candidates for transcatheter closure. Differentiate between types and sizes of atrial septal defects to determine suitability for device-based intervention. Implement evidence-based anticoagulation and antiplatelet protocols before, during, and after the procedure to ensure optimal patient care. Collaborate with echocardiographers, anesthesiologists, nurses, and pharmacists to optimize procedural outcomes. Access free multiple choice questions on this topic.

Atrial septal defect (ASD) is one of the most common congenital heart defects, with an estimated incidence of 6 to 10 per 10,000 live births.[1] ASDs are classified as primum, secundum, sinus venosus, and coronary sinus defects. The onset of symptoms varies among different patients, and many remain asymptomatic. Larger defects tend to cause symptoms early in life, while smaller defects often cause symptoms later in life. Symptoms include failure to thrive, shortness of breath, palpitations, enlargement of right heart chambers, peripheral edema, cyanosis, orthodeoxia-platypnea, and paradoxical embolism. Transcatheter closure of the ASD is currently available for secundum ASDs (see Image. Atrial Septal Defect Closure). Currently, 3 United States (US) Food and Drug Administration (FDA)-approved devices for ASD closure: the Amplatzer Septal Occluder, Amplatzer Cribriform, and Gore Cardioform Septal Occluder.

Major complications related to the transcatheter ASD closure include: Device embolization [16] Pulmonary embolism [16][17] Erosion of the cardiac structures from the device Atrial arrhythmias [18] Atrioventricular block [19] Persistent atrial aneurysm Thromboembolism Pericardial effusion and tamponade [20][21][22]

Effective catheter-based management of ASDs relies on a coordinated, multidisciplinary team approach. Interventional cardiologists lead the procedure, performing device deployment, sizing, and hemodynamic monitoring to ensure optimal outcomes. At the same time, echocardiographers provide real-time imaging guidance through transesophageal or intracardiac echocardiography to ensure accurate device placement and defect closure. Cardiac anesthesiologists or sedation specialists maintain hemodynamic stability and optimize patient comfort during the procedure. Catheterization laboratory nurses and technologists manage equipment, monitor vital signs, maintain sterile technique, and assist with device preparation and sheath insertion and removal. Postprocedure, advanced clinicians, pharmacists, and nurses coordinate anticoagulation and antiplatelet therapy, monitor for complications such as thrombus, arrhythmia, or vascular access issues, and educate patients on activity restrictions, endocarditis prophylaxis, and follow-up imaging. Effective communication between team members is critical for anticipating procedural challenges, responding to complications, and delivering patient-centered care. Collaboration across all roles enhances patient safety, improves clinical outcomes, and strengthens team performance while managing catheter-based ASD.