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ClearRounds Health · Cardiology · Quick Reference

PFO / ASD / VSD / PDA

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Valvular & Structural Heart DiseaseIntermediateIn progressOne-page PDF

Adult congenital basics, shunts, symptoms, echo clues, closure considerations, stroke/PFO pathway, and referral.

Combines PFO, ASD, VSD, and PDA.

Last reviewed

Pending initial clinical review

Sources / guidelines to verify

  • 2018 AHA/ACC Adult Congenital Heart Disease Guideline
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.

One-page reference

Draft content pending the site owner’s clinical review. Verify against the sources above and local protocol before clinical use.

1

What it is / why it matters

  • Adult shunts: PFO (common, usually benign, stroke link); ASD/VSD/PDA (left→right shunts that can overload the RV/PA).
  • A long-standing large shunt can reverse (Eisenmenger).
2

Key diagnostic clues

  • ASD: fixed split S2, RV heave; VSD: holosystolic murmur; PDA: continuous “machinery” murmur.
  • PFO is often silent — found during cryptogenic-stroke workup.
3

Initial workup

  • Echo with bubble study / TEE; assess shunt size (Qp:Qs), RV size, and PA pressures.
  • Cardiac MRI/CT as needed.
4

Management framework

  • Significant ASD/VSD/PDA with RV volume overload → closure (device or surgical) via ACHD.
  • PFO closure for selected cryptogenic stroke (younger, no other cause), with neurology.
  • Endocarditis awareness; avoid closure once Eisenmenger physiology is present.
5

Red flags / escalate now

  • Pulmonary HTN/Eisenmenger (cyanosis, low saturations), a large shunt, or paradoxical embolism → ACHD center.
6

Follow-up / monitoring

  • Echo surveillance; ACHD specialist co-management.
7

Clinic pearls

  • PFO closure is selective (cryptogenic stroke, shared decision-making).
  • Once pulmonary HTN/Eisenmenger develops, closing the defect can be harmful.

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ClearRounds Health · Cardiology — PFO / ASD / VSD / PDA Quick Reference · Last reviewed: Pending initial clinical review · Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.