Interatrial communications (atrial septal defects)

Routine follow-up for patients with small interatrial communications that do not require surgical closure should include assessment of symptoms, especially arrhythmias and paradoxic embolic events in adults. Pulmonary pressures, right ventricular function, and residual atrial shunting should be assessed by echocardiography. Patients who have had device closure of a secundum atrial septal defect should be assessed for symptoms of atrial arrhythmias, chest pain, or embolic events. Echocardiography is usually performed at 24 hours, 1 month, 3 months, and 1 year. Further monitoring is elective.[27]Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019 Apr 2;139(14):e698-800. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000603?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org http://www.ncbi.nlm.nih.gov/pubmed/30586767?tool=bestpractice.com ​ Attention should be paid to device placement, residual shunting, thrombus formation, and pericardial effusion.[27]Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019 Apr 2;139(14):e698-800. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000603?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org http://www.ncbi.nlm.nih.gov/pubmed/30586767?tool=bestpractice.com ​

Postoperative fever, chest or abdominal pain, vomiting, and fatigue may indicate pericardial effusion or cardiac tamponade and should be investigated immediately. Chest pain or syncope after device closure may be due to device erosion and should be investigated immediately.