What is the primary management for atrial septal defect (ASD) in symptomatic patients?

The primary management for atrial septal defect (ASD) in symptomatic patients is surgical closure. This approach is warranted when the defect leads to significant hemodynamic changes that result in symptoms such as exercise intolerance, fatigue, or palpitations. In symptomatic individuals, the presence of an ASD can lead to volume overload of the right atrium and right ventricle, potentially causing congestive heart failure or pulmonary hypertension over time.

Surgical closure or percutaneous intervention effectively alleviates these complications by correcting the abnormal blood flow between the atria. By closing the defect, it decreases the volume overload, improves the heart's efficiency, and prevents long-term sequelae associated with untreated ASD.

While other options, such as medications, monitoring, and cardiac catheterization, may have their roles in managing certain aspects of patient care or in less symptomatic cases, they do not address the underlying structural problem. Medications may help manage symptoms but do not resolve the defect itself. Monitoring might be appropriate for asymptomatic patients or those with small defects that do not significantly impact hemodynamics. Cardiac catheterization may be utilized for intervention but is not the primary management strategy in symptomatic cases. Thus, surgical closure stands out as the most definitive and effective treatment