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Patient handout

Adult atrial septal defect (chronic ACHD)

PRODUCTION

1. Your condition

This handout is for adult atrial septal defect (chronic achd). Your care team identified this based on: fixed split s2 / systolic flow murmur with rv heave.

Other reasons your team may use this plan: echo: asd with rv volume overload / left-to-right shunt; exertional dyspnea / new atrial fibrillation in adult; cryptogenic stroke / paradoxical embolism.

3. When to call your provider

Contact your care team if any of the following happen:

  • Severe PAH/Eisenmenger identified → STOP closure pathway, PAH therapy + route Eisenmenger — 2020 ESC ACHD
  • Decompensation/stroke → acute pathway — 2018 AHA/ACC ACHD
  • Persistent AF → AC + rhythm strategy — ESC 2024 AF

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • Severe PAH / Eisenmenger physiology (high PVR, bidirectional/R→L shunt, cyanosis) — ASD closure CONTRAINDICATED; PAH-targeted therapy + Eisenmenger precautions — 2020 ESC ACHD(life-threatening)
  • Qp:Qs ≥1.5 + RV volume overload + acceptable PVR — closure indicated (transcatheter secundum / surgical otherwise) — 2018 AHA/ACC ACHD
  • Cryptogenic stroke / paradoxical embolism via ASD/PFO — closure + anticoagulation consideration — 2018 AHA/ACC ACHD
  • Pregnancy with ASD — well-tolerated if no PAH (mWHO I–II); severe PAH/Eisenmenger = very high maternal mortality (pregnancy contraindicated); cardio-obstetric — ESC 2018 Pregnancy

5. Follow-up

Lifelong ACHD; pregnancy + transition planning; persistent-AF AC review

6. Sources

Guideline: 2018 AHA/ACC Adult Congenital Heart Disease Guideline (Stout) + 2020 ESC Adult Congenital Heart Disease Guideline (Baumgartner) + 2022 ESC/ERS Pulmonary Hypertension Guideline

  1. pubmed.ncbi.nlm.nih.gov/30121239
  2. pubmed.ncbi.nlm.nih.gov/32860028
  3. pubmed.ncbi.nlm.nih.gov/36017572