The American College of Cardiology/American Heart Association guidelines have recommended atrial septal defect (ASD) closure for patients with right atrial (RA) and right ventricular (RV) enlargement, regardless of symptoms (class I). Small ASDs (i.e., an ASD diameter of less than 5 mm) with no evidence of RV enlargement or pulmonary hypertension do not require closure because they are not considered significant enough to affect the clinical course or haemodynamics of these individuals. Smaller ASDs that are associated with paradoxical embolism or platypnea-orthodeoxia can be considered for closure according to guideline recommendations (class IIa). The only absolute contraindication for ASD closure pertains to patients with irreversible pulmonary hypertension (pulmonary vascular resistance greater than 8 Woods units) and no evidence of left-to-right shunting (class III). Sinus venosus and ostium primum defects are not suitable for percutaneous device closure because of poor anatomic and rim characteristics and the lack of randomized controlled trial data supporting this approach. The indications and contraindications to ASD and PFO closure are listed in Table 6.1.¹

Numerous devices exist for percutaneous transcatheter closure of ASDs and PFOs (Figure 6.1). The Amplatzer and the Gore PFO occlusion systems are approved by the US FDA for the percutaneous transcatheter closure of PFOs. The two types of devices currently approved in the United States for transcatheter closure of secundum ASDs are the Helex (W.L.Gore, Newark, DE) and Amplatzer (St. Jude Medical, Plymouth, MN) septal occlude devices² (Figure 6.1

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