Five years of atrial septal defect closure experience of a portuguese tertiary center

Background

Atrial septal defect (ASD) is the most common congenital heart lesion in adults. ASD closure (ASDC) is indicated in selected situations: paradoxical embolism, right heart volume overload (RHVO) or significant symptomatic burden.

Purpose

To characterize the population undergoing ASDC in a tertiary center in Portugal between January 2020 and October 2025.

Methods

All consecutive patients who underwent ASDC during the study period were included. Baseline characteristics, procedural indications, device selection, and follow-up outcomes were analyzed. The one-sample proportion test was used for proportion comparison and the Fisher’s exact test was used for comparison between categorical variables.

Results

100 ASDC procedures were undertaken. 81 ASDC procedures (81% of all ASDC procedures) were performed for RHVO, 17 (17%) for paradoxical embolism and 2 (2%) for decompensated heart failure (DHF).

ASDC patients were 49±17 years-old. Among the 100 ASDC patients, 66 (66%) were female (p=0.002 vs. 50%). When analyzed by subgroup, 57 RHVO patients (70.4%) were female (p=0.0005 vs. 50%), while 9 embolism patients (52.9%) were female (p=0.69 vs. 50%).

Three ASDC patients (3%) were hospitalized patients: one RHVO patient (1.2% of all RHVO cases) and both patients who required intervention for DHF.

Regarding the procedure, a standard septal occluder was used in 94 cases, a multifenestrated septal occluder in 5 cases, and a cribriform device in 1 case.

During follow-up, 2 patients (2%) required at least one hospitalization (both were RHVO patients [2.5% of the total RHVO patients]).

Among the 87 patients with at least 6 months of follow-up, 19 (21.8%) had residual shunt. Residual shunt was present in 11 RHVO patients (15.5% of the 71 with ≥6 months of follow-up) and in 7 embolism patients (46.7% of the 15 with ≥6 months of follow-up), with a significant difference between groups (p=0.01).

Conclusions

In conclusion, the majority of procedures were performed for RHVO. Patients treated for paradoxical embolism showed no gender predominance, whereas RHVO patients were predominantly female. Urgent interventions were uncommon, procedural success was high across device types and early clinical events during follow-up were rare. Residual shunting was particularly frequent among embolic patients.