Ostium Secundum Atrial Septal Defects

No Results

No Results


An ostium secundum atrial septal defect is an abnormally large opening in the atrial septum at the site of the foramen ovale and the ostium secundum.

In the early embryo heart, the atria comprise a common chamber. As the atria enlarge, the septum primum forms and grows toward the developing atrioventricular canal area, which is later divided by the superior and inferior endocardial cushions. These cushions fuse and bend with their convexity toward the atria, thereby approaching the down-growing septum primum. This process continually narrows the passageway between the atria, which is then defined as the ostium primum. [1]

The ostium primum completely closes; however, before this occurs, a central perforation appears in septum primum, allowing continuous unrestricted flow from the right atrium to the left atrium. This perforation, the second opening in the septum primum, is called ostium secundum. As the atria expand to either side of the truncus arteriosus, a fold is produced within the atria just to the right of septum primum. This passively formed fold is septum secundum. The leading edge of septum secundum is concave in shape and is called the foramen ovale. It comes to overlay the ostium secundum but does not interfere with blood flow from right to left through ostium secundum. After birth, with onset of pulmonary blood flow and elevation of left atrial pressure, the septum primum is pushed against the septum secundum, effectively closing the ostium secundum.

Fusion of the septum primum and the septum secundum closes the foramen ovale. Complete closure occurs in most individuals. In 25-30% of normal adult hearts, however, a probe can be passed from the right atrium to the left atrium via the foramen ovale and ostium secundum. This patent foramen ovale allows a tiny left-to-right shunt that can be detected by sensitive techniques, such as color Doppler echocardiography, in 15-20% of adults.

A secundum atrial septal defect is usually bordered by the edge of the fossa ovalis and the exposed circumference of ostium secundum. The shape of the defect varies from circular to oval. Less often, strands of tissue cross the defect creating a fenestrated appearance that suggests multiple defects. Rarely, a defect can extend posteriorly and inferiorly, approaching the site of inferior vena cava entrance into the right atrium. [2]

A secundum atrial septal defect can result from inadequate formation of the septum secundum so that it does not completely cover the ostium secundum. More often, the ostium secundum is excessively large because of increased resorption so that septum secundum cannot cover it.

Although heart failure from secundum atrial septal defect rarely occurs in children, this complication can often occur in adults. Adults also demonstrate a propensity for atrial dysrhythmias, including atrial flutter and fibrillation, presumably caused by chronic right atrial dilation. These complications may not be reversible if closure is delayed. Data indicate that closure in persons older than 40 years does not reduce the risk of atrial dysrhythmia. Spontaneous closure of a small secundum atrial septal defect does occur and is usually documented when the initial diagnosis is made early in infancy. [3, 4] A moderate atrial septal defect may also decrease significantly in size or even close when the defect is diagnosed early in life. [5] However, defects diagnosed later in childhood seldom decrease in size and many significantly increase in size. [6]

The foramen ovale mechanism remains patent in at least 15% of adults (echocardiography can identify clinically insignificant shunts with this frequency). Some of these individuals could be classified as having a small secundum atrial septal defect. The presence of this phenomenon has been identified as a potential risk factor for stroke due to embolization into the systemic arterial circulation. [7]

Although unusual, obstructive pulmonary vascular disease may occur in adults with an atrial septal defect. [8]

The surgical mortality rate should be less than 0.1%. If defects are closed in children younger than 8 years, the prognosis is excellent, with rare short-term or long-term cardiac abnormalities. [9]

Patients with incomplete closure or closure at older age remain at risk for development of cardiac rhythm disturbances. Whether closure of a secundum atrial septal defect in a person older than 40 years alters the patient’s risk of either cardiac disability or limitation of life remains controversial. [10]

An isolated secundum atrial septal defect very seldom causes significant symptoms in pediatric patients, regardless of defect size.

Note the following:

Rarely, an infant may develop congestive heart failure in the presence of a secundum atrial septal defect. Whether the defect alone is responsible for causing heart failure is not well established, although it certainly adds to the patient’s hemodynamic difficulties. Failure to thrive caused only by a secundum atrial septal defect is, similarly, a rare occurrence.

Bacterial endocarditis is not a risk with this lesion and the American Heart Association does not advise use of antibiotic prophylaxis.

No data indicate that an uncomplicated secundum atrial septal defect can cause pulmonary vascular disease in pediatric patients.

A patient with primary pulmonary hypertension may demonstrate a secundum atrial septal defect, but no cause-and-effect relationship can be established.

Patients with a significant secundum atrial septal defect who live at an altitude higher than 4000 feet may incur a small risk of developing pulmonary vascular disease.

Death from an isolated secundum atrial septal defect does not occur in pediatric patients.

Surgical damage to the sinoatrial node occurs rarely when experienced individuals accomplish closure. Short and long-term postoperative rhythm disturbances can occur, however, particularly when closure of a large defect is delayed beyond early childhood (ie, >8 y).

Late complications of device closure can include rhythm disturbance, perforation of the heart, fracture of the supporting structures of the device, and residual shunts. Long-term late complications remain unknown.

No significant racial influences have been identified.

Secundum atrial septal defect occurs more commonly in females than males, with a female-to-male ratio of 2:1.

Secundum atrial septal defect is a congenital abnormality and, therefore, is present at birth. It may be diagnosed at any age, including early infancy, although the characteristic findings on physical examination often escape detection until the patient reaches a few years of age. An acquired defect occurs only iatrogenically.


Isolated secundum atrial septal defects account for approximately 7% of congenital cardiac defects. Congenital heart defects of significance occur in approximately 8 per 1000 live births. Therefore, 5-6 cases of secundum atrial septal defect occur per 10,000 live births. This number refers only to defects that are large enough to come to clinical attention. Many small defects that remain undetected occur in addition to numerous cases of patent foramen ovale, as mentioned above.

Gessner IH. Atrial septal defect. Surgery of Congenital Heart Disease: Pediatric Care Consortium 1984-1995. Armonk, NY: Futura Publishing Co.; 1998. 31-44.

Vick GW, Titus JL. Defects of the atrial septum, including the atrioventricular canal. Garson A, Bricker JT, Fisher, DJ, Neish, SR eds. The Science and Practice of Pediatric Cardiology. Baltimore, MD: Lippincott Williams & Wilkins; 1998. Vol 2:

Azhari N, Shihata MS, Al-Fatani A. Spontaneous closure of atrial septal defects within the oval fossa. Cardiol Young. 2004 Apr. 14(2):148-55. [Medline].

Saxena A, Divekar A, Soni NR. Natural history of secundum atrial septal defect revisited in the era of transcatheter closure. Indian Heart J. 2005 Jan-Feb. 57(1):35-8. [Medline].

Hanslik A, Pospisil U, Salzer-Muhar U, Greber-Platzer S, Male C. Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. Pediatrics. 2006 Oct. 118(4):1560-5. [Medline]. [Full Text].

McMahon CJ, Feltes TF, Fraley JK, et al. Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart. 2002 Mar. 87(3):256-9. [Medline].

Scheuerle A. Clinical differentiation of patent foramen ovale and secundum atrial septal defect: a survey of pediatric cardiologists in Dallas, Texas, USA. J Registry Manag. 2011 Spring. 38(1):4-8. [Medline].

Sachweh JS, Daebritz SH, Hermanns B, et al. Hypertensive pulmonary vascular disease in adults with secundum or sinus venosus atrial septal defect. Ann Thorac Surg. 2006 Jan. 81(1):207-13. [Medline].

Siddiqui WT, Parveen S, Siddiqui MT, Amanullah MM. Clinical outcomes of surgically corrected atrial septal defects. J Pak Med Assoc. 2013 May. 63(5):662-5. [Medline].

Brochu MC, Baril JF, Dore A, et al. Improvement in exercise capacity in asymptomatic and mildly symptomatic adults after atrial septal defect percutaneous closure. Circulation. 2002 Oct 1. 106(14):1821-6. [Medline]. [Full Text].

Caputo S, Capozzi G, Russo MG, et al. Familial recurrence of congenital heart disease in patients with ostium secundum atrial septal defect. Eur Heart J. 2005 Oct. 26(20):2179-84. [Medline].

Sznajer Y, Keren B, Baumann C, et al. The spectrum of cardiac anomalies in Noonan syndrome as a result of mutations in the PTPN11 gene. Pediatrics. 2007 Jun. 119(6):e1325-31. [Medline]. [Full Text].

Godwin KA, Sibbald B, Bedard T, Kuzeljevic B, Lowry RB, Arbour L. Changes in frequencies of select congenital anomalies since the onset of folic acid fortification in a Canadian birth defect registry. Can J Public Health. 2008 Jul-Aug. 99(4):271-5. [Medline].

Arrington CB, Tani LY, Minich LL, Bradley DJ. An assessment of the electrocardiogram as a screening test for large atrial septal defects in children. J Electrocardiol. 2007 Nov-Dec. 40(6):484-8. [Medline].

Wu ET, Akagi T, Taniguchi M, et al. Differences in right and left ventricular remodeling after transcatheter closure of atrial septal defect among adults. Catheter Cardiovasc Interv. 2007 May 1. 69(6):866-71. [Medline].

Walker RE, Moran AM, Gauvreau K, Colan SD. Evidence of adverse ventricular interdependence in patients with atrial septal defects. Am J Cardiol. 2004 Jun 1. 93(11):1374-7, A6. [Medline].

Giardini A, Donti A, Formigari R, et al. Determinants of cardiopulmonary functional improvement after transcatheter atrial septal defect closure in asymptomatic adults. J Am Coll Cardiol. 2004 May 19. 43(10):1886-91. [Medline].

Rigatelli G, Dell’ Avvocata F, Cardaioli P, Giordan M, Vassiliev D, Nghia NT, et al. Five-year Follow-up of Intracardiac Echocardiography-assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect. Congenit Heart Dis. 2011 Oct 20. [Medline].

Brassard M, Fouron JC, van Doesburg NH, Mercier LA, De Guise P. Outcome of children with atrial septal defect considered too small for surgical closure. Am J Cardiol. 1999 Jun 1. 83(11):1552-5. [Medline].

Doll N, Walther T, Falk V, et al. Secundum ASD closure using a right lateral minithoracotomy: five-year experience in 122 patients. Ann Thorac Surg. 2003 May. 75(5):1527-30; discussion 1530-1. [Medline].

Argenziano M, Oz MC, Kohmoto T, et al. Totally endoscopic atrial septal defect repair with robotic assistance. Circulation. 2003 Sep 9. 108 Suppl 1:II191-4. [Medline]. [Full Text].

Atashband A, Lakkis N. First Comprehensive Analysis of Outcomes in Adult Patients after Percutaneous Closure of Isolated Secundum Atrial Septal Defects. Cardiovasc Hematol Agents Med Chem. 2015. 13 (1):63-9. [Medline].

Shah D, Azhar M, Oakley CM, et al. Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study. Br Heart J. 1994 Mar. 71(3):224-7; discussion 228. [Medline].

Bolz D, Lacina T, Buser P, et al. Long-term outcome after surgical closure of atrial septal defect in childhood with extensive assessment including MRI measurement of the ventricles. Pediatr Cardiol. 2005 Sep-Oct. 26(5):614-21. [Medline].

Lock JE, Cockerham JT, Keane JF, et al. Transcatheter umbrella closure of congenital heart defects. Circulation. 1987 Mar. 75(3):593-9. [Medline].

Jones TK, Latson LA, Zahn E, et al. Results of the U.S. multicenter pivotal study of the HELEX septal occluder for percutaneous closure of secundum atrial septal defects. J Am Coll Cardiol. 2007 Jun 5. 49(22):2215-21. [Medline].

Patel A, Lopez K, Banerjee A, Joseph A, Cao QL, Hijazi ZM. Transcatheter closure of atrial septal defects in adults > or =40 years of age: immediate and follow-up results. J Interv Cardiol. 2007 Feb. 20(1):82-8. [Medline].

Post MC, Suttorp MJ, Jaarsma W, Plokker HW. Comparison of outcome and complications using different types of devices for percutaneous closure of a secundum atrial septal defect in adults: a single-center experience. Catheter Cardiovasc Interv. 2006 Mar. 67(3):438-43. [Medline].

Shimizu S, Kawamura A, Arai T, Ohno Y, Mogi S, Kodaira M, et al. Intracardiac echocardiography for percutaneous closure of atrial septal defects: initial experiences in Japan. Cardiovasc Interv Ther. 2013 May 26. [Medline].

Stroker E, Van De Bruaene A, De Meester P, Van Deyck K, Gewillig M, Budts W. Transcatheter device closure of atrial septal defects in patients above age 60. Acta Cardiol. 2013 Apr. 68(2):127-32. [Medline].

Kazmouz S, Kenny D, Cao QL, Kavinsky CJ, Hijazi ZM. Transcatheter closure of secundum atrial septal defects. J Invasive Cardiol. 2013 May. 25(5):257-64. [Medline].

Taniguchi M, Akagi T, Kijima Y, Sano S. Clinical advantage of real-time three-dimensional transesophageal echocardiography for transcatheter closure of multiple atrial septal defects. Int J Cardiovasc Imaging. 2013 Apr 23. [Medline].

Chen TH, Hsiao YC, Cheng CC, et al. In-Hospital and 4-Year Clinical Outcomes Following Transcatheter Versus Surgical Closure for Secundum Atrial Septal Defect in Adults: A National Cohort Propensity Score Analysis. Medicine (Baltimore). 2015 Sep. 94 (38):e1524. [Medline]. [Full Text].

Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A. Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med. 2007 Nov 29. 357(22):2262-8. [Medline].

Vida VL, Barnoya J, O’Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects: results and cost-effective considerations in a low-income country. J Am Coll Cardiol. 2006 Jan 17. 47(2):326-31. [Medline].

Butera G, Carminati M, Chessa M, et al. Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications. Am Heart J. 2006 Jan. 151(1):228-34. [Medline].

Giardini A, Donti A, Specchia S, Formigari R, Oppido G, Picchio FM. Long-term impact of transcatheter atrial septal defect closure in adults on cardiac function and exercise capacity. Int J Cardiol. 2008 Feb 29. 124(2):179-82. [Medline].

Ira H Gessner, MD Professor Emeritus, Pediatric Cardiology, University of Florida College of Medicine

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alvin J Chin, MD Emeritus Professor of Pediatrics, University of Pennsylvania School of Medicine

Disclosure: Nothing to disclose.

Syamasundar Rao Patnana, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children’s Memorial Hermann Hospital

Syamasundar Rao Patnana, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Paul M Seib, MD Associate Professor of Pediatrics, University of Arkansas for Medical Sciences; Medical Director, Cardiac Catheterization Laboratory, Co-Medical Director, Cardiovascular Intensive Care Unit, Arkansas Children’s Hospital

Paul M Seib, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Arkansas Medical Society, International Society for Heart and Lung Transplantation, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Ostium Secundum Atrial Septal Defects

Research & References of Ostium Secundum Atrial Septal Defects|A&C Accounting And Tax Services