Atrial Septal Defect: When Is Surgery Necessary?

Atrial Septal Defect (ASD) is a common type of congenital heart disease. In general, if the diameter of the defect exceeds 5mm, surgical intervention may be recommended. Additionally, the age of the patient plays a significant role in determining the appropriate timing for treatment. Typically, children over the age of 2 are considered suitable candidates for surgery, while those younger than 2 usually do not require immediate intervention. Below is a more detailed overview:

Defect Size and Treatment Options

If the ASD is smaller than 5mm, especially in cases where it's 2-3mm in size, surgical repair is generally not required. In such cases, regular follow-ups with echocardiography every 6 months to a year are sufficient to monitor the condition. This applies particularly to central-type ASDs. However, if the defect is larger than 5mm, regardless of whether it's an upper vena cava type, lower vena cava type, or central type, surgical or interventional treatment becomes a viable option.

There are two primary treatment methods available: traditional open-chest surgical repair and minimally invasive transcatheter closure. Each has its own advantages and disadvantages. Whenever possible, transcatheter closure is preferred due to its less invasive nature, faster recovery time, and reduced risk of complications. Central-type ASDs are particularly well-suited for this type of closure. On the other hand, lower vena cava type defects may not be ideal for transcatheter closure due to anatomical considerations.

Age Considerations for Surgery

Why Age 2 Is a Key Benchmark

Children who are over the age of 2 typically have larger peripheral blood vessels, which makes interventional procedures safer and less likely to cause vascular injury. This also reduces the risk of complications such as impaired blood flow to the lower limbs. Performing such procedures on children younger than 2 can be more challenging due to smaller vessel size and the child's limited ability to tolerate anesthesia and other medical interventions. This can negatively affect both the safety and effectiveness of the treatment.