排除标准 Exclusion Criteria

• 患者年龄大于21岁
• 患者具有充血性心律衰竭
• 患者具有肺血管阻塞性疾病

定义分流大小 Definition of Shunt Size

• Small shunt: Absence of diastolic flow rumble, normal chest x-ray, echocardiographic evidence of normal right ventricular dimension, and normal interventricular septal motion or a pulmonary to systemic flow ratio (QP/QS) <1.5.
• Large shunt: Presence of a diastolic flow rumble or ECG evidence of right ventricular hypertrophy, chest radiographic evidence of cardiomegaly or increased pulmonary vascular markings, or echocardiographic evidence of right ventricular enlargement or paradoxical septal motion or a QP/QS>= 1.5.

临床协议说明

Two algorithms were developed for the management of ostium secundum atrial septal defect. For one, "Time 0" is the initial evaluation by a pediatric cardiologist and the patient is aged 5 years or younger at the time of the initial evaluation. For the other, "Time 0" is the initial evaluation by a pediatric cardiologist but the patient is older than 5 years at the time of that evaluation.

For patients initially evaluated at the age of 5 years or younger, the algorithm allows for medical treatment or surgical closure (ie, off protocol) for symptomatic patients with a large left-to-right shunt. The algorithm also allows for continued observation of patients with a large left-to-right shunt and symptoms in anticipation of possible spontaneous closure of the atrial septal defect. In asymptomatic patients with a large left-to-right shunt, surgical closure should be performed between 2 and 5 years of age.

For patients initially evaluated when they were older than 5 years, the atrial septal defect can be closed electively, assuming there are no contraindications to surgery. p