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Mechanism of spontaneous closure of ASD

July 2, 2014 by dr s venkatesan

Spontaneous closure of VSD is  a well recognised  phenomenon, than ASD  though both happen in equal frequency.The simple reason being VSD is a noisy disease , ironically the smaller the size of VSD  more noisy it is . Hence  it is rarely  missed  while ASD is largely silent in children. For this reason  it is  possible ASD may be the most common congenital disease .

Natural history of ASD(OS) closure

  • ASDs of size 3-4 mm 100 % will close by 3  years
  • Bulk of the ASD < 8  mm close spontaneously by 5 years.
  • ASD> 10mm is unlikely to close

Factors that determine spontaneous closure

  • Apart from size and location
  • Closure  is accelerated by remnant of flap of foramen  ovale
  • Fenestrations and  Septal  aneurysms also  favor spontaneous closure.
  • Margins  of the defect if rough  triggers fibrotic reactions

spontaneous closure of asd

Why SVC and primum defect do not close easily ?

Plane of ASD  secundum is single and  bridging of tissue is possible .

Sinus venous and  primum defects exhibit  holes which run in multiple planes hence approximation not possible . They also do not  have a valve mechanism.

Un-natural history of ASD

In the current era, one more  force interferes  with spontaneous closure of ASD . It  comes from the  hyper trained aggressive Interventional cardiologists who compete with the nature and easily prevail over it !

Reference

asd spontaneous closure

1.Craig RJ, Selzer A. Natural history and prognosis of atrial septal defect. Circulation. 1968;37:805–815.
2.Hanslik A1, Pospisil U, Salzer-Muhar U,Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study.Pediatrics. 2006 Oct;118(4):1560-5.

3.David Radzik, André Davignon,Nicolaas van Doesburg, Predictive factors for spontaneous closure of atrial septal defects diagnosed in the first 3 months of life J Am Coll Cardiol. 1993;22(3):851-853. 

Coming soon

Iam saying it as PFO  . . .  How do you say it is an ASD ?

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Posted in ASD device closure, cardiology -congenital heart disease | Tagged acute dilatation of right atrium ra, asd device closure vs spontaneous closure, ostium secundum asd, spontaneous closure of ASD, what is the mechansim of spontaneous closure of asd, will a 3 5 8 10mm asd close spontaneously ? |

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