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Education in Heart
Congenital heart disease in adult patients
Simple cardiac shunts in adults: atrial septal defects, ventricular septal defects, patent ductus arteriosus
  1. Daniel Tobler1,
  2. Matthias Greutmann2
  1. 1 Cardiology, University Hospital Basel, Basel, Switzerland
  2. 2 Cardiology, University Hospital Zurich, Zurich, Switzerland
  1. Correspondence to Dr Daniel Tobler, Cardiology, University Hospital Basel, Basel 4031, Switzerland; daniel.tobler{at}usb.ch

https://doi.org/10.1136/heartjnl-2019-314700

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    Learning objectives

    • To understand the anatomy, pathophysiology and complications of simple septal defects and patent ductus arteriosus in adults.

    • To understand general management recommendations of simple shunt lesions.

    • To select patients for interventional and surgical repair.

    Introduction

    Simple shunt lesions are among the most common forms of congenital heart disease.1 Depending on location and size of the shunts, haemodynamic effects and presentation vary considerably. For example, while haemodynamically relevant ventricular septal defects (VSDs) nowadays typically are managed during childhood, atrial septal defects (ASDs) often escape diagnosis in childhood and many patients are diagnosed in adult life.2 Therefore, general cardiologists are frequently confronted with diagnosis and management of interatrial communications. This article focuses on anatomy, pathophysiology, natural history and common complications of simple shunt lesions; discusses imaging techniques and invasive procedures to diagnose and manage ASDs and VSDs and provides a practical algorithm on how to manage patients with ASDs with and without pulmonary hypertension.

    Anatomy and pathophysiology of simple shunt lesions

    Atrial septal defects

    ​Anatomy of ASDs

    ASD are defined as direct communications on the atrial level.

    The ostium secundum ASD (figure 1A1) is located within the fossa ovalis but may extend in any direction. In contrast to a patent foramen ovale (PFO), which is a flap-valve of tissue formed by the septum primum and septum secundum, an ostium secundum ASD is characterised by a true tissue defect of variable size. Occasionally, there may be multiple defects or a combination of an ostium secundum ASD in addition to a PFO with or without an associated atrial septal aneurysm.

    Figure 1

    Anatomy and haemodynamic consequences of simple shunt lesions. Panels (1A and 1B) anatomy of secundum atrial septal defects and haemodynamic consequences of relevant left-to-right shunting in interatrial communications. Panels (2A and 2B) anatomy of muscular ventricular septal defects and haemodynamic consequences of relevant left-to-right shunting. Panels (3A and 3B) anatomy of patent ductus arteriosus and the …

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    Footnotes

    • Contributors Both authors have contributed to the manuscript equally.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Author note References which include a * are considered to be key references.