Atrial septal defect transthoracic echocardiography

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Atrial Septal Defect Microchapters


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Ostium Secundum Atrial Septal Defect
Ostium Primum Atrial Septal Defect
Sinus Venosus Atrial Septal Defect
Coronary Sinus
Patent Foramen Ovale
Common or Single Atrium


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Transesophageal Echocardiography
Transthoracic Echocardiography
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ACC/AHA Guidelines for Evaluation of Unoperated Patients


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]


Echocardiography is the preferred diagnostic tool in the evaluation of an atrial septal defect. Transthoracic echocardiography is an effective two-dimensional modality that can be used to identify suspected atrial septal defects.

Transthoracic Echocardiography

  • Effective two-dimensional modality for visualizing an ostium secundum atrial septal defect.
  • Types:
  • Apical four chamber view
  • Subcoastal four chamber view
  • Provides imaging of:
  • Right ventricular enlargement
  • Paradoxical motion involving the ventricular septum
  • Right atrium enlargement
Transthoracic echocardiogram four chamber view to evaluate atrial septal defect. Note presence of inter-atrial communication between left and right atrium.
Transesophageal echocardiogram showing Amplatzer device placed across the defect forming a “sandwich” over the atrial septal defect
Transthoracic echocardiogram four chamber view one day after Amplatzer device placement
Transthoracic echocardiogram one day after Amplatzer device placed with highlighted area that shows no further shunting of blood across atrial septum


  • Determines which type of defect exists.
  • Necessary to evaluate for anomalous pulmonary veins.
  • Evaluates for an atrial septal aneurysm.



  • One study found that subcostal approach could successfully visualize the majority of ostium primum and ostium secundum atrial septal defects.[1]
  • Visualization of sinus venosus atrial septal defect is less successful, less than 50% of the cases were properly imaged.[1]

2008 ACC / AHA Guidelines - Evaluation of the Unoperated Patient- Atrial Septal Defect (DO NOT EDIT)[2]

Class I
"1. ASD should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of RV volume overload and any associated anomalies. (Level of Evidence: C) "


  1. 1.0 1.1 Shub C, Dimopoulos IN, Seward JB, Callahan JA, Tancredi RG, Schattenberg TT; et al. (1983). "Sensitivity of two-dimensional echocardiography in the direct visualization of atrial septal defect utilizing the subcostal approach: experience with 154 patients". J Am Coll Cardiol. 2 (1): 127–35. PMID 6853907.
  2. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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