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ACC/AHA GUIDELINES FOR ASD
CLOSURE: WHAT’S NEW IN 2011?
Prof Pham Nguyen Vinh, MD, PhD, FACC
Pham Ngoc Thach University of Medicine
Tam Duc Heart Hospital
1
ACC/AHA guideline for ASD closure: what’s new in 2011?
Classification of indication and level of
evidence (1) • Indications:
– Class I:
• Benefit >>> Risk
• SHOULD
– Class II: conflicting evidence of usefulness
• IIa: In favor of usefulness/efficacy
• IIb: Usefulness/efficacy: less well established
– Class III:
• Risk > Benefit
• Procedure/ treatment is not useful
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ACC/AHA guideline for ASD closure: what’s new in 2011?
Classification of indication and level of
evidence (2)
• Level of evidences
– A: evidences from ≥ 2 randomized, controlled
trials or a meta analysis.
– B: evidences from 1 randomized, controlled trial or
some non-randomized studies.
– C: consensus/ experts; case studies; standard of
care
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ACC/AHA guideline for ASD closure: what’s new in 2011?
Atrial septal defect (1)
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ACC/AHA guideline for ASD closure: what’s new in 2011?
Atrial septal defect (2)
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ACC/AHA guideline for ASD closure: what’s new in 2011?
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ACC/AHA guideline for ASD closure: what’s new in 2011?
Indications for intervention of ASD (2010)
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TL: Baumgartner H et al. ESC Guideline for the management of grown-up congenital heart
disease (2010). Eur. H. J (2010) 31; 2915-2957
ACC/AHA guideline for ASD closure: what’s new in 2011?
Indications for intervention of ASD (2010)
TL: Baumgartner H et al. ESC Guideline for the management of grown-up congenital heart
disease (2010). Eur. H. J (2010) 31; 2915-2957 8
ACC/AHA guideline for ASD closure: what’s new in 2011?
9
TL: Feltes TF et al. indications for Cardiac Catheterization and Intervention in Pediatric Cardiac
Disease: A Scientific Statement from American Heart Association Circerlation 2011; 123: 2607-2652
ACC/AHA guideline for ASD closure: what’s new in 2011?
General Recommendations for Cardiac
Catheterization Preparation
TL: Feltes TF et al. indications for Cardiac Catheterization and Intervention in Pediatric Cardiac
Disease: A Scientific Statement from American Heart Association Circerlation 2011; 123: 2607-2652
10
ACC/AHA guideline for ASD closure: what’s new in 2011?
Recommendations for Diagnostic
Catheterization
TL: Feltes TF et al. indications for Cardiac Catheterization and Intervention in Pediatric Cardiac
Disease: A Scientific Statement from American Heart Association Circerlation 2011; 123: 2607-2652 11
ACC/AHA guideline for ASD closure: what’s new in 2011?
Recommendations for Transcatheter Device
Closure of Secundum ASD (1)
TL: Feltes TF et al. indications for Cardiac Catheterization and Intervention in Pediatric Cardiac
Disease: A Scientific Statement from American Heart Association Circerlation 2011; 123: 2607-2652 12
ACC/AHA guideline for ASD closure: what’s new in 2011?
Recommendations for Transcatheter Device
Closure of Secundum ASD (2)
TL: Feltes TF et al. indications for Cardiac Catheterization and Intervention in Pediatric Cardiac
Disease: A Scientific Statement from American Heart Association Circerlation 2011; 123: 2607-2652 13
ACC/AHA guideline for ASD closure: what’s new in 2011?
Recommendations for Transcatheter Device
Closure of Secundum ASD (3)
TL: Feltes TF et al. indications for Cardiac Catheterization and Intervention in Pediatric Cardiac
Disease: A Scientific Statement from American Heart Association Circerlation 2011; 123: 2607-2652
14
ACC/AHA guideline for ASD closure: what’s new in 2011?
Recommendations for Transcatheter Device
Closure of Secundum ASD (4)
TL: Feltes TF et al. indications for Cardiac Catheterization and Intervention in Pediatric Cardiac
Disease: A Scientific Statement from American Heart Association Circerlation 2011; 123: 2607-2652 15
ACC/AHA guideline for ASD closure: what’s new in 2011?
Conlusion • 1976 by Mills and King: first closure of ASD
• Now, ASD closure by device: a routine
procedure for ASDos < 38 mm (# 80% of
patients)
• Not much change for indication
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