Atrial septal defect is a very common heart malformation, although the degree of this malformation is not complicated, but due to the high incidence, thus troubling many patients. The following are the unified answers to patient concerns: 1. Do I have an atrial septal defect or not? Many patients, in this hospital, have an atrial septal defect diagnosed by cardiac ultrasound, and in another hospital, the ultrasound believes there is no atrial septal defect. The human atrial septum is not in one plane, and due to the different angles of the ultrasound probe, Dr. Zhang San thinks there is an atrial septal defect, while Dr. Li Si thinks there is no atrial septal defect. This is a very common situation. In fact, an experienced surgeon will never diagnose an atrial septal defect based solely on ultrasound findings. They will first listen. If a hyperactive second pulmonary valve sound is heard with a fixed split, then an atrial septal defect is basically present. If further chest radiographs suggest increased pulmonary blood, an enlarged right atrioventricular chamber, and a prominent pulmonary artery segment. The electrocardiogram suggests right atrial enlargement. This is further evidence of the presence of an atrial septal defect. Again, have the sonographer repeatedly view it from different angles so that it is not missed. Transesophageal ultrasound can also help in the diagnosis. 2.What are the current treatments for atrial septal defect? The current treatments for atrial septal defects include transthoracic occlusion, transfemoral vein (thigh root) occlusion, minimally invasive surgical repair via the right axilla, and surgical repair via a median sternotomy. Transthoracic thoracoscopic repair of atrial septal defect. 3.What are the indications for occlusion surgery? Atrial septal defect is divided into primary and secondary septal defects. Secondary septal defects are divided into superior, central and inferior septal defects. Currently, only the central type of secondary septal defect can be blocked. Moreover, not all central septal defects can be occluded. Each side of the central septal defect must be long enough to allow the occluder to snap firmly into place without dislodging. Transfemoral (root of thigh) vein occlusion requires that the patient’s femoral vein be thick enough to deliver the occluder to the heart, and therefore, requires a certain age of the patient. The age requirement of the patient varies from one interventionalist to another. Transthoracic occlusion has no strict age requirement, and an incision of about 1 cm in the chest is sufficient. For giant atrial septal defect, even if the above mentioned blocking conditions are met, blocking procedure should not be performed. What is meant by a giant atrial septal defect? It is defined relative to the size of the patient’s heart. For example, if a patient weighs 50-60 kg and has an atrial septal defect of more than 30 mm, a blocking device of more than 32 mm must be selected if the blocking is performed, and the weight of the blocking device should be about 2-3 taels by the time it really works. The patient will be very uncomfortable with such a weight hanging inside his heart. Similarly, in a 1-year-old child with an atrial septal defect of 20 mm or more, the patient will be very uncomfortable after the blocking procedure. Of course, if the indications are chosen reasonably, blocking is a good choice. 4.What are the disadvantages of occlusion? The most terrible complication of blocking is heart rupture, which can occur at an indefinite time after blocking. The cause of the rupture is that the blocker wears out the right atrial wall near the interatrial sulcus. The patient presents with sudden death. Other complications include mitral valve insufficiency, tricuspid valve insufficiency, complete atrioventricular block, and aortic sinus rupture. These complications are, of course, rare. Once they occur, surgery is required to remove the blocker and repair it accordingly. 5.When is the right time to operate? The previous mentioned is blocking surgery. If surgical treatment is considered, it is generally considered appropriate around the age of 1 year. If the patient has difficulty feeding, does not gain weight, and has recurrent pneumonia, there is no age restriction. Theoretically, all simple atrial septal defects can be performed minimally invasively under the right axilla or transthoracic thoracoscopic repair of atrial septal defects. Some local hospitals, which cannot perform cardiac surgery around the age of 1 year, will recommend that patients come in at the age of 3 to 5 years, which is not absolutely not possible. However, a recent study has shown that if a patient’s right atrium is significantly enlarged before surgery, the rate of atrial fibrillation in the patient’s adult life is no different than in patients who did not have surgery. 6. How large an atrial septal defect should be treated? It is generally accepted that atrial septal defects of less than 5 mm can be left untreated, but this is not absolute. Although the atrial septal defect is not large, there is a possibility of forming paradoxical thrombosis, which is not uncommon in clinical practice. 7.How to distinguish atrial septal defect from patent foramen ovale? If the atrial septum only shows structural separation and there is no leftward shunt, it is called foramen ovale unclosed, and vice versa, it is called foramen ovale type atrial septal defect (a kind of central atrial septal defect).