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

2

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

3

ACC/AHA guideline for ASD closure: what’s new in 2011?

Atrial septal defect (1)

4

ACC/AHA guideline for ASD closure: what’s new in 2011?

Atrial septal defect (2)

5

ACC/AHA guideline for ASD closure: what’s new in 2011?

6

ACC/AHA guideline for ASD closure: what’s new in 2011?

Indications for intervention of ASD (2010)

7

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

16