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
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