| 释义 |
- Presentation Complications Decompression sickness Eisenmenger's syndrome Paradoxical embolus Migraine
- Causes
- Types Ostium secundum atrial septal defect Natural history Patent foramen ovale Ostium primum atrial septal defect Sinus venosus atrial septal defect Common or single atrium Mixed atrial septal defect
- Mechanisms
- Diagnosis Physical examination Echocardiography Transcranial doppler bubble study Electrocardiogram
- Treatment Patent Foramen Ovale PFO Closure Medical Therapy Atrial Septal Defect Evaluation prior to correction Surgical closure Catheter procedure
- Epidemiology
- References Additional references
- External links
{{short description|A heart defect present at birth in which blood can flow through an opening between the top chambers of the heart}}{{Infobox medical condition (new)
| name = Atrial septal defect
| image = Asd-web.jpg
| caption = Illustration of an atrial septal defect.
| field = Cardiac surgery
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}}Atrial septal defect (ASD) is a heart defect in which blood flows between the atria (upper chambers) of the heart. Some flow is a normal condition both pre-birth and immediately post-birth via the foramen ovale, however when this does not naturally close after birth it is referred to as a patent (open) foramen ovale (PFO). Normally, after PFO closure, the atria are separated by a dividing wall, the interatrial septum. If this septum is defective or absent, then oxygen-rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart, or vice versa.[1] This can lead to lower-than-normal oxygen levels in the arterial blood that supplies the brain, organs, and tissues. However, an ASD may not produce noticeable signs or symptoms, especially if the defect is small. Also, in terms of health risks, people who have had a cryptogenic stroke are more likely to have a PFO than the general population.[2]A "shunt" is the presence of a net flow of blood through the defect, either from left to right or right to left. The amount of shunting present, if any, determines the hemodynamic significance of the ASD. A "right-to-left-shunt" typically poses the more dangerous scenario. During development of the baby, the interatrial septum develops to separate the left and right atria. However, a hole in the septum called the foramen ovale, allows blood from the right atrium to enter the left atrium during fetal development. This opening allows blood to bypass the nonfunctional fetal lungs while the fetus obtains its oxygen from the placenta. A layer of tissue called the septum primum acts as a valve over the foramen ovale during fetal development. After birth, the pressure in the right side of the heart drops as the lungs open and begin working, causing the foramen ovale to close entirely. In about 25% of adults,[3] the foramen ovale does not entirely seal.[4] In these cases, any elevation of the pressure in the pulmonary circulatory system (due to pulmonary hypertension, temporarily while coughing, etc.) can cause the foramen ovale to remain open. {{TOC limit|3}}PresentationComplicationsDue to the communication between the atria that occurs in ASDs, disease entities or complications from the condition are possible. Patients with an uncorrected atrial septal defect may be at increased risk for developing a cardiac arrhythmia, as well as more frequent respiratory infections.[5] Decompression sicknessASDs, and particularly PFOs, are a predisposing venous blood carrying inert gases, such as helium or nitrogen does not pass through the lungs.[5][6] The only way to release the excess inert gases from the body is to pass the blood carrying the inert gases through the lungs to be exhaled. If some of the inert gas-laden blood passes through the PFO, it avoids the lungs and the inert gas is more likely to form large bubbles in the arterial blood stream causing decompression sickness. Eisenmenger's syndrome{{main|Eisenmenger's syndrome}}If a net flow of blood exists from the left atrium to the right atrium, called a left-to-right shunt, then an increase in the blood flow through the lungs happens. Initially, this increased blood flow is asymptomatic, but if it persists, the pulmonary blood vessels may stiffen, causing pulmonary hypertension, which increases the pressures in the right side of the heart, leading to the reversal of the shunt into a right-to-left shunt. Reversal of the shunt occurs, and the blood flowing in the opposite direction through the ASD is called Eisenmenger's syndrome, a rare and late complication of an ASD. Paradoxical embolusVenous thrombus (clots in the veins) are quite common. Embolizations (dislodgement of thrombi) normally go to the lung and cause pulmonary emboli. In an individual with ASD, these emboli can potentially enter the arterial system, which can cause any phenomenon attributed to acute loss of blood to a portion of the body, including cerebrovascular accident (stroke), infarction of the spleen or intestines, or even a distal extremity (i.e., finger or toe). This is known as a paradoxical embolus because the clot material paradoxically enters the arterial system instead of going to the lungs. Migraine{{Main|Migraine surgery#Patent foramen ovale closure}}Some recent research has suggested that a proportion of cases of migraine may be caused by PFO. While the exact mechanism remains unclear, closure of a PFO can reduce symptoms in certain cases.[7][8] This remains controversial; 20% of the general population has a PFO, which for the most part, is asymptomatic. About 20% of the female population has migraines, and the placebo effect in migraine typically averages around 40%. The high frequency of these facts make finding statistically significant relationships between PFO and migraine difficult (i.e., the relationship may just be chance or coincidence). In a large randomized controlled trial, the higher prevalence of PFO in migraine patients was confirmed, but migraine headache cessation was not more prevalent in the group of migraine patients who underwent closure of their PFOs.[9] Causes- Down syndrome – patients with Down syndrome have higher rates of ASDs, especially a particular type that involves the ventricular wall.[10] As many as one half of Down syndrome patients have some type of septal defect.[10]
- Ebstein's anomaly[11] – about 50% of individuals with Ebstein anomaly have an associated shunt between the right and left atria, either an atrial septal defect or a patent foramen ovale.[12]
- Fetal alcohol syndrome – about one in four patients with fetal alcohol syndrome has either an ASD or a ventricular septal defect.[13]
- Holt–Oram syndrome – both the osteium secundum and osteum primum types of ASD are associated with Holt–Oram syndrome[14]
- Lutembacher's syndrome – the presence of a congenital ASD along with acquired mitral stenosis[17]
TypesThe many types of atrial septal defects are differentiated from each other by whether they involve other structures of the heart and how they are formed during the developmental process during early fetal development. Ostium secundum atrial septal defectThe ostium secundum atrial septal defect is the most common type of atrial septal defect, and comprises 6–10% of all congenital heart diseases. The secundum atrial septal defect usually arises from an enlarged foramen ovale, inadequate growth of the septum secundum, or excessive absorption of the septum primum. About 10 to 20% of individuals with ostium secundum ASDs also have mitral valve prolapse.[15] An ostium secundum ASD accompanied by an acquired mitral valve stenosis is called Lutembacher's syndrome.[16] Natural historyMost individuals with an uncorrected secundum ASD do not have significant symptoms through early adulthood. More than 70% develop symptoms by about 40 years of age. Symptoms are typically decreased exercise tolerance, easy fatigability, palpitations, and syncope. Complications of an uncorrected secundum ASD include pulmonary hypertension, right-sided heart failure, atrial fibrillation or flutter, stroke, and Eisenmenger's syndrome. While pulmonary hypertension is unusual before 20 years of age, it is seen in 50% of individuals above the age of 40. Progression to Eisenmenger's syndrome occurs in 5 to 10% of individuals late in the disease process.[16] Patent foramen ovaleA patent foramen ovale (PFO) is a remnant opening of the fetal foramen ovale, which normally closes after a person's birth. In medical use, the term "patent" means open or unobstructed.[17] In about 25% of people, the foramen ovale fails to close properly, leaving them with a PFO or at least with what some physicians classify as a "pro-PFO", which is a PFO that is normally closed, but can open under increased blood pressure. On echocardiography, shunting of blood may not be noted except when the patient coughs. Clinically, PFO is linked to stroke, sleep apnea, migraine with aura, and decompression sickness. No cause is established for a foramen ovale to remain open instead of closing naturally, but heredity and genetics may play a role.[18][19] PFO is not treated in the absence of other symptoms. The mechanism by which a PFO may play a role in stroke is called paradoxical embolism. In the case of PFO, a blood clot from the venous circulatory system is able to pass from the right atrium directly into the left atrium via the PFO, rather than being filtered by the lungs, and thereupon into systemic circulation toward the brain.[20][21] PFO is common in patients with an atrial septal aneurysm (ASA), a much-more rare condition, which is also linked to cryptogenic (i.e., of unknown cause) stroke.[22] PFO is more prevalent in patients with cryptogenic stroke than in patients with a stroke of known cause.[23] While PFO is present in only 25% in the general population, the probability of someone having a PFO increases to about 40 to 50% in patients who have had a cryptogenic stroke. Statistically speaking, this is particularly true for patients who have a stroke before the age of 55.[24] Some data suggest that PFOs may be involved in the pathogenesis of some migraine headaches.[25] Several clinical trials are currently underway to investigate the role of PFO in these clinical situations.[25] Ostium primum atrial septal defect{{Main|Ostium primum atrial septal defect}}A defect in the ostium primum is occasionally classified as an atrial septal defect,[26] but it is more commonly classified as an atrioventricular septal defect.[27][28] Ostium primum defects are less common than ostium secundum defects.[29] This type of defect is usually associated with Down syndrome. Sinus venosus atrial septal defectA sinus venosus ASD is a type of atrial septum defect in which the defect involves the venous inflow of either the superior vena cava or the inferior vena cava. A sinus venosus ASD that involves the superior vena cava makes up 2 to 3% of all interatrial communication. It is located at the junction of the superior vena cava and the right atrium. It is frequently associated with anomalous drainage of the right-sided pulmonary veins into the right atrium (instead of the normal drainage of the pulmonary veins into the left atrium).[30] Common or single atriumCommon (or single) atrium is a failure of development of the embryologic components that contribute to the atrial septal complex. It is frequently associated with heterotaxy syndrome.[31] Mixed atrial septal defect The interatrial septum can be divided into five septal zones. If the defect involves two or more of the septal zones, then the defect is termed a mixed atrial septal defect.[32] MechanismsIn unaffected individuals, the chambers of the left side of the heart are under higher pressure than the chambers of the right side because the left ventricle has to produce enough pressure to pump blood throughout the entire body, while the right ventricle needs only to produce enough pressure to pump blood to the lungs. In the case of a large ASD (> 9 mm), which may result in a clinically remarkable left-to-right shunt, blood shunts from the left atrium to the right atrium. This extra blood from the left atrium may cause a volume overload of both the right atrium and the right ventricle. If untreated, this condition can result in enlargement of the right side of the heart and ultimately heart failure.[32] Any process that increases the pressure in the left ventricle can cause worsening of the left-to-right shunt. This includes hypertension, which increases the pressure that the left ventricle has to generate to open the aortic valve during ventricular systole, and coronary artery disease which increases the stiffness of the left ventricle, thereby increasing the filling pressure of the left ventricle during ventricular diastole. The left-to-right shunt increases the filling pressure of the right heart (preload) and forces the right ventricle to pump out more blood than the left ventricle. This constant overloading of the right side of the heart causes an overload of the entire pulmonary vasculature. Eventually, pulmonary hypertension may develop. The pulmonary hypertension will cause the right ventricle to face increased afterload. The right ventricle is forced to generate higher pressures to try to overcome the pulmonary hypertension. This may lead to right ventricular failure (dilatation and decreased systolic function of the right ventricle). If the ASD is left uncorrected, the pulmonary hypertension progresses and the pressure in the right side of the heart becomes greater than the left side of the heart. This reversal of the pressure gradient across the ASD causes the shunt to reverse - a right-to-left shunt. This phenomenon is known as Eisenmenger's syndrome. Once right-to-left shunting occurs, a portion of the oxygen-poor blood gets shunted to the left side of the heart and ejected to the peripheral vascular system. This causes signs of cyanosis.
11. ^{{cite journal|last=Cherry|first=C|author2=DeBord, S|author3= Moustapha-Nadler, N|title=Ebstein's anomaly: a complex congenital heart defect.|journal=AORN Journal|date=June 2009|volume=89|issue=6|pages=1098–110; quiz 1111–4|pmid=19606562|doi=10.1016/j.aorn.2009.03.003}}
12. ^[https://books.google.ae/books?id=nE2VAwAAQBAJ&pg=PA119 p.119] Jaypee Brothers, First Edition 2014, {{ISBN|978-93-5152-140-2}}.
13. ^{{cite journal|last=Burd|first=L|author2=Deal, E|author3= Rios, R|author4= Adickes, E|author5= Wynne, J|author6= Klug, MG|title=Congenital heart defects and fetal alcohol spectrum disorders|journal=Congenital Heart Disease|date=July–August 2007|volume=2|issue=4|pages=250–5|pmid=18377476|doi=10.1111/j.1747-0803.2007.00105.x}}
14. ^{{cite journal|last=Bossert|first=T|author2=Walther, T|author3= Gummert, J|author4= Hubald, R|author5= Kostelka, M|author6= Mohr, FW|title=Cardiac malformations associated with the Holt–Oram syndrome – report on a family and review of the literature|journal=The Thoracic and Cardiovascular Surgeon|date=October 2002|volume=50|issue=5|pages=312–4|pmid=12375192|doi=10.1055/s-2002-34573}}
15. ^{{cite journal |vauthors=Leachman R, Cokkinos D, Cooley D | title = Association of ostium secundum atrial septal defects with mitral valve prolapse | journal = Am J Cardiol | volume = 38 | issue = 2 | pages = 167–9 | year = 1976 | pmid = 952260 | doi = 10.1016/0002-9149(76)90144-2}}
16. ^1 2 {{Harvnb|Goldman|2011|pp=400–401}}
17. ^{{cite web | title = patent | work = Medical Dictionary | publisher = TheFreeDictionary.com | date = September 1, 2014 | url = http://medical-dictionary.thefreedictionary.com/patent | accessdate = 2015-03-26 }}
18. ^{{cite web|url=http://www.childrenshospital.org/conditions-and-treatments/conditions/patent-foramen-ovale/symptoms-and-causes|title=Patent Foramen Ovale Symptoms & Causes - Boston Children's Hospital|first=Boston Childrens Hospital|last=2013}}
19. ^{{cite web|url=http://www.texasheart.org/HIC/Topics/Cond/pfo.cfm|title=Patent Foramen Ovale - Texas Heart Institute Heart Information Center}}
20. ^{{cite web|url=http://www.heart.org/HEARTORG/Conditions/More/CardiovascularConditionsofChildhood/Patent-Foramen-Ovale-PFO_UCM_469590_Article.jsp#.V46EhrgrJhE|title=Patent Foramen Ovale (PFO)}}
21. ^{{cite journal |vauthors=Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, Felberg R, Herrmann H, Kar S, Landzberg M, Raizner A, Wechsler L |title=Closure or medical therapy for cryptogenic stroke with patent foramen ovale |journal=The New England Journal of Medicine |volume=366 |issue=11 |pages=991–9 |year=2012 |pmid=22417252 |doi=10.1056/NEJMoa1009639 }}
22. ^1 2 {{cite journal |vauthors=Freixa X, Arzamendi D, Tzikas A, Noble S, Basmadjian A, Garceau P, Ibrahim R |title=Cardiac procedures to prevent stroke: patent foramen ovale closure/left atrial appendage occlusion |journal=The Canadian Journal of Cardiology |volume=30 |issue=1 |pages=87–95 |year=2014 |pmid=24365193 |doi=10.1016/j.cjca.2013.11.008 }}
23. ^{{cite journal |last1=Homma |first1=Shunichi |last2=Sacco |first2=Ralph L |last3=Di Tullio |first3=Marco R |last4=Sciacca |first4=Robert R |last5=Mohr |first5=JP |title=Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study |journal=Circulation |volume=105 |issue=22 |pages=2625–31 |year=2002 |pmid=12045168 |doi=10.1161/01.CIR.0000017498.88393.44 }}
24. ^{{cite web|url=http://www.heart.org/HEARTORG/Conditions/More/CardiovascularConditionsofChildhood/Patent-Foramen-Ovale-PFO_UCM_469590_Article.jsp#.V419hpMrLeQ|title=Patent Foramen Ovale (PFO)}}
25. ^1 {{cite journal |vauthors=McCandless RT, Arrington CB, Nielsen DC, Bale JF, Minich LL |title=Patent foramen ovale in children with migraine headaches |journal=The Journal of Pediatrics |volume=159 |issue=2 |pages=243–7.e1 |year=2011 |pmid=21450305 |doi=10.1016/j.jpeds.2011.01.062 }}
26. ^{{cite web |url=http://www.mayoclinic.org/atrial-septal-defect/types.html |title=Atrial Septal Defect Types – Mayo Clinic |accessdate=2007-10-14 |website=| archiveurl= https://web.archive.org/web/20070928010431/http://www.mayoclinic.org/atrial-septal-defect/types.html| archivedate= 28 September 2007 | deadurl= no}}
27. ^{{cite book |author1=Fix, James D. |author2=Dudek, Ronald W. |title=Embryology |publisher=Williams & Wilkins |location=Baltimore |year=1998 |pages=52 |isbn=978-0-683-30272-1 |oclc= |doi=}}
28. ^{{ICD10|Q|21|2|q|20}}
29. ^1 {{cite book|last=Skelley|first=Tao Le, Vikas Bhushan, Nathan William|title=First aid for the USMLE step 2 CK|publisher=McGraw–Hill Medical|location=New York|isbn=978-0-07-176137-6|pages=357|edition=8th|date=2012-03-12}}
30. ^{{cite journal |vauthors=Davia J, Cheitlin M, Bedynek J | title = Sinus venosus atrial septal defect: analysis of fifty cases | journal = Am Heart J | volume = 85 | issue = 2 | pages = 177–85 | year = 1973 | pmid = 4569755 | doi = 10.1016/0002-8703(73)90458-4}}
31. ^{{cite book |author1=Valdes-Cruz, L. M. |author2=Cayre, R. O. | title=Echocardiographic diagnosis of congenital heart disease | location=Philadelphia | year=1998}}
32. ^1 {{cite journal|last=John|first=J|author2=Abrol, S|author3= Sadiq, A|author4= Shani, J|title=Mixed atrial septal defect coexisting ostium secundum and sinus venosus atrial septal defect.|journal=Journal of the American College of Cardiology|date=Jul 26, 2011|volume=58|issue=5|pages=e9|pmid=21777739|url=http://content.onlinejacc.org/cgi/content/full/58/5/e9|accessdate=17 June 2012|doi=10.1016/j.jacc.2010.11.077}}
33. ^{{Harvnb|Goldman|2011|pp=270}}
34. ^{{cite journal |last=Glen |first=S. |author2=J. Douglas. |title=Transcranial doppler monitoring. (letter to editor) |journal=South Pacific Underwater Medicine Society Journal |volume=25 |issue=2 |year=1995 |issn=0813-1988 |oclc=16986801 |url=http://archive.rubicon-foundation.org/6409 |accessdate=2008-04-06 }}
35. ^{{cite journal |vauthors=Clark E, Kugler J | title = Preoperative secundum atrial septal defect with coexisting sinus node and atrioventricular node dysfunction | journal = Circulation | volume = 65 | issue = 5 | pages = 976–80 | year = 1982 | pmid = 7074763 | doi = 10.1161/01.CIR.65.5.976}}
36. ^1 2 {{cite web|title=UOTW #54 - Ultrasound of the Week|url=https://www.ultrasoundoftheweek.com/uotw-54/|website=Ultrasound of the Week|accessdate=27 May 2017|date=30 July 2015}}
37. ^{{Cite web|url=https://www.uptodate.com/contents/patent-foramen-ovale?search=patent%20foramen%20ovale&source=search_result&selectedTitle=1~92&usage_type=default&display_rank=1#H9|title=UpToDate|website=www.uptodate.com|access-date=2018-08-04}}
38. ^1 2 {{Cite journal|last=Mir|first=Hassan|last2=Siemieniuk|first2=Reed Alexander C.|last3=Ge|first3=Long Cruz|last4=Foroutan|first4=Farid|last5=Fralick|first5=Michael|last6=Syed|first6=Talha|last7=Lopes|first7=Luciane Cruz|last8=Kuijpers|first8=Ton|last9=Mas|first9=Jean-Louis|date=2018-07-01|title=Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: a systematic review and network meta-analysis incorporating complementary external evidence|url=https://bmjopen.bmj.com/content/8/7/e023761|journal=BMJ Open|language=en|volume=8|issue=7|pages=e023761|doi=10.1136/bmjopen-2018-023761|issn=2044-6055|pmc=6067350|pmid=30049703}}
39. ^{{Cite journal|last=Mas|first=Jean-Louis|last2=Derumeaux|first2=Geneviève|last3=Guillon|first3=Benoît|last4=Massardier|first4=Evelyne|last5=Hosseini|first5=Hassan|last6=Mechtouff|first6=Laura|last7=Arquizan|first7=Caroline|last8=Béjot|first8=Yannick|last9=Vuillier|first9=Fabrice|date=2017-09-14|title=Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke|journal=New England Journal of Medicine|language=EN|volume=377|issue=11|pages=1011–1021|doi=10.1056/nejmoa1705915|pmid=28902593|issn=0028-4793}}
40. ^{{Cite journal|last=Søndergaard|first=Lars|last2=Kasner|first2=Scott E.|last3=Rhodes|first3=John F.|last4=Andersen|first4=Grethe|last5=Iversen|first5=Helle K.|last6=Nielsen-Kudsk|first6=Jens E.|last7=Settergren|first7=Magnus|last8=Sjöstrand|first8=Christina|last9=Roine|first9=Risto O.|date=2017-09-14|title=Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke|journal=New England Journal of Medicine|language=EN|volume=377|issue=11|pages=1033–1042|doi=10.1056/nejmoa1707404|pmid=28902580|issn=0028-4793}}
41. ^{{Cite journal|last=Saver|first=Jeffrey L.|last2=Carroll|first2=John D.|last3=Thaler|first3=David E.|last4=Smalling|first4=Richard W.|last5=MacDonald|first5=Lee A.|last6=Marks|first6=David S.|last7=Tirschwell|first7=David L.|date=2017-09-14|title=Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke|journal=New England Journal of Medicine|language=EN|volume=377|issue=11|pages=1022–1032|doi=10.1056/nejmoa1610057|pmid=28902590|issn=0028-4793}}
42. ^{{cite journal|last1=Kuijpers|first1=Ton|last2=Spencer|first2=Frederick A|last3=Siemieniuk|first3=Reed A C|last4=Vandvik|first4=Per O|last5=Otto|first5=Catherine M|last6=Lytvyn|first6=Lyubov|last7=Mir|first7=Hassan|last8=Jin|first8=Albert Y|last9=Manja|first9=Veena|date=25 July 2018|title=Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke? A clinical practice guideline|journal=BMJ|pages=k2515|doi=10.1136/bmj.k2515|pmid=30045912|last10=Karthikeyan|first10=Ganesan|last11=Hoendermis|first11=Elke|last12=Martin|first12=Janet|last13=Carballo|first13=Sebastian|last14=O’Donnell|first14=Martin|last15=Vartdal|first15=Trond|last16=Baxter|first16=Christine|last17=Patrick-Lake|first17=Bray|last18=Scott|first18=Joanie|last19=Agoritsas|first19=Thomas|last20=Guyatt|first20=Gordon}}
43. ^{{cite web|url=https://www.uptodate.com/contents/practice-changing-updates?search=pfo+closure+stroke&source=search_result&selectedTitle=3~150|title=UpToDate|author=|date=|website=www.uptodate.com}}
44. ^{{cite web|url=https://www.uptodate.com/contents/treatment-of-patent-foramen-ovale-pfo-for-secondary-stroke-prevention?sectionName=Our+approach&anchor=H8&source=see_link#H8|title=UpToDate|author=|date=|website=www.uptodate.com}}
45. ^{{cite web|url=http://my.clevelandclinic.org/health/treatments_and_procedures/hic_Endovascular_Patent_Foramen_Ovale_PFO_Closure/hic_how_is_a_patient_foramen_ovale_pfo_closed_using_catheter_based_procedure|title=How is a Patent Foramen Ovale (PFO) Closed Using a Catheter-based Procedure?|publisher=Cleveland Clinic|accessdate=20 July 2016}}
46. ^{{cite web|url=http://www.medscape.com/viewarticle/852810|title=RESPECT 10-Year Data Strengthens Case for PFO Closure After Cryptogenic Stroke|last=Brauser|first=Deborah|date=16 October 2015|website=Medscape|accessdate=20 July 2016}}
47. ^1 {{cite journal|last1=Kuijpers|first1=JM|last2=Mulder|first2=BJ|last3=Bouma|first3=BJ|date=April 2015|title=Secundum atrial septal defect in adults: a practical review and recent developments|journal=Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation|volume=23|issue=4|pages=205–11|doi=10.1007/s12471-015-0663-z|pmc=4368528|pmid=25884091}}
48. ^{{cite journal|last1=Shah|first1=Rahman|last2=Nayyar|first2=Mannu|last3=Jovin|first3=Ion S.|last4=Rashid|first4=Abdul|last5=Bondy|first5=Beatrix R.|last6=Fan|first6=Tai-Hwang M.|last7=Flaherty|first7=Michael P.|last8=Rao|first8=Sunil V.|title=Device Closure Versus Medical Therapy Alone for Patent Foramen Ovale in Patients With Cryptogenic Stroke|journal=Annals of Internal Medicine|volume=168|issue=5|pages=335|date=9 January 2018|doi=10.7326/M17-2679|pmid=29310136}}
49. ^{{cite journal|last1=De Rosa|first1=Salvatore|last2=Sievert|first2=Horst|last3=Sabatino|first3=Jolanda|last4=Polimeni|first4=Alberto|last5=Sorrentino|first5=Sabato|last6=Indolfi|first6=Ciro|title=Percutaneous Closure Versus Medical Treatment in Stroke Patients With Patent Foramen Ovale|journal=Annals of Internal Medicine|volume=168|issue=5|pages=343|date=9 January 2018|doi=10.7326/M17-3033|pmid=29310133}}
50. ^{{cite journal | author = Bjørnstad P | title = Is interventional closure the current treatment of choice for selected patients with deficient atrial septation? | journal = Cardiol Young | volume = 16 | issue = 1 | pages = 3–10 | year = 2006 | pmid = 16454871 | doi = 10.1017/S1047951105002027}}
51. ^{{cite journal | author = Kaplan S | title = Congenital heart disease in adolescents and adults. Natural and postoperative history across age groups | journal = Cardiol Clin | volume = 11 | issue = 4 | pages = 543–56 | year = 1993 | pmid = 8252558| doi = 10.1016/S0733-8651(18)30137-1 }}
52. ^{{cite journal |vauthors=Feldt R, Avasthey P, Yoshimasu F, Kurland L, Titus J | title = Incidence of congenital heart disease in children born to residents of Olmsted County, Minnesota, 1950–1969 | journal = Mayo Clin Proc | volume = 46 | issue = 12 | pages = 794–9 | year = 1971 | pmid = 5128021}}
{{HHS content|url=http://www.nhlbi.nih.gov/health/dci/Diseases/holes/holes_treatments.html|title = National Heart, Lung, and Blood Institute}}
Additional references- {{cite book|last=Goldman|first=Lee|title=Goldman's Cecil Medicine|publisher=Elsevier Saunders|location=Philadelphia|isbn=978-1437727883|year=2011|pages=270, 400–401|edition=24th|ref=harv}}
External links {{Medical resources
| DiseasesDB = 1089
| ICD10 = {{ICD10|Q|21|1|q|20}}
| ICD9 = {{ICD9|745.5}}-{{ICD9|745.6}}
| ICDO =
| OMIM = 108800
| MedlinePlus = 000157
| eMedicineSubj = med
| eMedicineTopic = 3519
| eMedicine_mult = {{eMedicine2|article|894813}}
}}- Atrial Septal Defect – Stanford Children's Health
- [https://web.archive.org/web/20100116165108/http://www.pediatricheartsurgery.com/ Pediatric Heart Surgery]
- [https://www.youtube.com/user/Redmond111 The Congenital Heart Surgery Video Project]
- [https://www.youtube.com/watch?v=PbQhiv6OB0E Pediatric Cardiac Surgery: Atrial Septal Defect Repair]
- Atrial septal defect information for parents.
- Atrial septal defects in infants and children.
{{Congenital malformations and deformations of circulatory system}}{{Diving medicine}}{{DEFAULTSORT:Atrial Septal Defect}} 2 : Congenital heart defects|Diving medicine |