AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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The diagnosis is ostium pimum atrial septal defect. The defect occurs at the base of the interatrial septum and is due to the failure of the formation of the septum primum.
Surgical correction has excellent results with a mortality less than 1%. The reoperation rate is less than 3%. The repair can be done through a standard incision or minimally invasive technique. A ostium primum ASD was associated with coarctation of the aorta which increases the mortality and morbidity.
Ostium primum ASDs can also be corrected by a percutaneous placement of a closure device, however, we could not find a study that focused only on ostium primum ASDs. Most of the studies were secundum ASDs with maybe a few primum ASDs included. For secundum ASDs, a 4.9% residual shunt was present for all types of anatomical presentations of the secundum ASDs (eccentric shunt with valve, widely redundant septum primum, large defect > 10 mm, cribiform ASD, tunnel form ASD, interatrial septal aneursym). While the study focused on secundum ASDs, it shows that 100% of a widely varying presentation of an ASD can be closed with a device with good results.
In one report, a highly fenestrated septum primum resulted in failure of closure by a device. Of course, ostium primum ASDs can be associated with other congenital abnormalities that may not allow the use of a device to close the defect.
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Primum atrial septal defect.
Anatomical patterns of patent foramen ovale (PFO): do they matter for percutaneous closure?
Evolution of surgical techniques for atrial septal defect repair in adults: a 10-year single-institution experience.
Thoracoscopic ASD closure is a reliable supplement for percutaneous treatment.
Transthoracic three-dimensional echocardiography in the preoperative assessment of atrioventricular septal defect morphology.