The following are key points to remember from this review of atrial septal defect (ASD) in adults:

1. ASD is the most common congenital heart disease diagnosed in adulthood, accounting for 25-30% of diagnoses.
2. Secundum ASDs account for 80% of ASDs and are located within the fossa ovalis. Device closure is the treatment of choice when feasible.
3. Sinus venosus defects account for 5-6% of ASDs and generally occur near the entry of the superior vena cava to the right atria and are associated with anomalous pulmonary venous return. Less common are inferior sinus venosus defects. Surgical repair has historically been the approach of choice, although transcatheter intervention with covered stents has emerged as an alternative.
4. Primum ASDs account for 15% of ASDs and occur adjacent to the atrioventricular (AV) valves. Associated AV valve abnormalities are common, and surgical intervention is the accepted treatment.
5. Coronary sinus defects account for <1% of ASDs and occur because of unroofing of the tissue separating the coronary sinus from the left atrium. They are associated with persistent left superior vena cava and are treated surgically.
6. Echocardiography remains the first-line imaging modality for ASDs. Information obtained by echo includes size and location of defects, assessment of right ventricular chamber size, and estimation of right ventricular pressures.
7. Cardiac magnetic resonance imaging has an important role in the imaging of ASD when additional information is required after echocardiography and provides accurate measures of right ventricular size and function, location of pulmonary veins, and quantification of the pulmonary-to-systemic flow ratio (Qp:Qs).
8. Diagnostic catheterization for adults with ASD should be reserved for patients with pulmonary hypertension, left heart disease, or older patients in which there are concerns for coronary artery disease.
9. Medical therapy for pulmonary arterial hypertension should be considered for patients with ASD and pulmonary vascular resistance (PVR) ≥5 WU. For patients with PVR ≥5 WU despite pulmonary hypertension therapy, ASD closure should be avoided and advanced pulmonary hypertension therapies provided.
10. Atrial flutter and atrial fibrillation are common in patients with ASD, with prevalence increasing with age. In patients >60 years of age, 20% experience atrial flutter and 50% experience atrial fibrillation.
11. Patients with ASD may benefit from lifelong adult congenital heart disease care, specifically those undergoing repair later in life or those with primum ASDs and associated AV valve abnormalities.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, Pulmonary Hypertension, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Hypertension

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Cardiac Surgical Procedures, Coronary Artery Disease, Coronary Sinus, Diagnostic Imaging, Echocardiography, Heart Defects, Congenital, Heart Septal Defects, Atrial, Hypertension, Pulmonary, Magnetic Resonance Imaging, Persistent Left Superior Vena Cava, Pulmonary Arterial Hypertension, Scimitar Syndrome, Stents, Vascular Resistance, Vena Cava, Superior

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