An 8-year-old child is incidentally found to have a systolic murmur. Echocardiography reveals a secundum ASD with left-to-right shunt, Qp:Qs of 2.2:1, and mild right ventricular dilatation. There are no symptoms. Which statement about management of this secundum ASD is MOST accurate?

• A Surgical closure is mandatory because catheter-based device closure has inferior long-term outcomes
• B Closure should be deferred until adulthood as spontaneous closure may occur at this age
• C Pharmacological management with diuretics and ACE inhibitors is sufficient given absence of symptoms
• D Device closure (e.g., Amplatzer occluder) via transcatheter approach is preferred if defect anatomy is suitable ✓

Explanation

For significant secundum ASDs (Qp:Qs >1.5:1 with RV volume overload), closure is recommended before age 5 to prevent late complications (atrial arrhythmias, paradoxical embolism, pulmonary hypertension). In children over 3 years with adequate septal rims and defect size <38 mm, transcatheter device closure using devices like the Amplatzer Septal Occluder is the preferred approach as it avoids cardiopulmonary bypass, has equivalent efficacy to surgery, and has shorter hospital stay. Spontaneous closure of secundum ASD rarely occurs after age 4 and essentially does not occur with significant shunts. Pharmacological therapy does not address the structural defect.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.