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Editorial
Closing atrial septal defects for prevention of stroke: how small is too small?
  1. Alain Fraisse1,2,
  2. Sébastien Hascoet3,
  3. Aleksander Kempny2,4
  1. 1 Paediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2 National Heart and Lung Institute, Imperial College London, London, UK
  3. 3 Congenital Heart Diseases, Centre Chirugical Marie Lannelongue, Le Plessis-Robinson, France
  4. 4 Adult Congenital Heart Disease Unit, Royal Brompton Hospital, London, UK
  1. Correspondence to Professor Alain Fraisse, Paediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; a.fraisse{at}rbht.nhs.uk

https://doi.org/10.1136/heartjnl-2021-320064

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    The main indication for closing a secundum atrial septal defect (ASD) is a significant left-to-right shunt, with acceptable pulmonary vascular resistances.1 2 Transcatheter closure has become an accepted alternative to surgical repair for most types of ostium secundum ASD. The technique is commonly referred to for patients with a defect under 38 mm in diameter without deficient rims and allows safe and effective ASD closure in most unselected cases. The main limit for percutaneous closure is the size of the defect as well as the existence of appropriate rims.1–3 In many patients referred for transcatheter closure, the question is often ‘How large is too large?’3

    In Dolgner et al’s4 study, the above-mentioned statements are challenged after they report 10% of stroke in a selected study population of 346 patients with a secundum ASD and no known atrial arrhythmias. The authors provide a risk stratification based on the three following independent risk factors for this population: a body mass index >25, smoking and a prominent Eustachian valve. They conclude that ASD closure could be considered in this patient population, even without a significant left-to-right shunt.4 This study is remarkable because this is the …

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    Footnotes

    • Contributors AF reviewed the paper and wrote the editorial alongside SH. AK reviewed and corrected the paper with AF.

    • 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 AF is a consultant for Abbott and Occlutech.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Commissioned; internally peer reviewed.

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