Advances in Atrial Septal Defect Closure: Managing Pulmonary Hypertension and Expanding Treatment Criteria Applicability

Atrial septal defects (ASDs) are common congenital heart anomalies that can have significant long-term implications, particularly in the presence of pulmonary hypertension (PH). If left untreated, there is an increased risk of heart failure and Eisenmenger syndrome leading to a subsequent increase in patient morbidity and mortality. Advances in surgical and transcatheter closure techniques have improved outcomes, though challenges remain, particularly in patients with severe PH. This review highlights current secundum ASD closure methods, including open heart and transcatheter approaches, and explores the potential of biodegradable devices under development. Furthermore, recent guidelines for closure are discussed with an emphasis on PH management. In addition, the treat-and-repair strategy is discussed in the context of a meta-analysis and case reports, which show promise in expanding eligibility for closure in patients when used in conjunction with PH reversibility testing. The importance of multidisciplinary care in optimizing patient outcomes is emphasized and the need for further research is noted to refine strategies, improve device safety, and extend ASD closure guidelines to a broader patient population.