Timing of Intervention for closure of defects in Acyanotic Congenital Heart Disease

Atrial Septal Defect (ASD)

• Ostium secundum ASD is closed between 2-4 years of age.
• Ostium primum ASD: If not associated with other cardiac lesions like PDA or VSD, then it can be followed by a cardiologist and   closed between 2-3 years of age. But if associated with moderate to severe mitral valve regurgitation, then it should be closed by one year of age.
• Sinus venous type  ASD: It Should be closed by 4-5 years of age.

Patent Ductus Arteriosus PDA

• If a PDA has persisted beyond the Neonatal period, the further decision for timing for closure is based on the size of PDA and degree of dilatation of left heart chambers on Echocardiography.
• If size of PDA is small with no dilatation of left heart chambers then it can be followed up by a cardiologist  at periodic interval. Generally small PDA is closed between 12-18 months of age. 
• In case of a moderate sized PDA, which is usually associated with left heart dilatation, it should be closed by 6 months-1 year of age.In case of a large sized PDA, an age of  3-6 months is appropriate for closure

Ventricular Septal Defect(VSD)

• A small VSD can be followed upto 4 to 5 years of age as patient’s growth is not hampered due to the lesion itself. 
• A moderate sized VSD with dilated left ventricle with adequate growth of the child can wait for a closure till 1-2 years of age depending upon other symptoms of the child related to increased pulmonary flow. 
• A large VSD, should be closed by 3-6 months of age