Post-Operative Day 1 Workup Following ASD Device Closure

Clinical Assessment

The American College of Cardiology and American Heart Association recommend evaluating patients for symptoms of arrhythmia, chest pain, embolic events, fever, fatigue, vomiting, or abdominal pain, as these may indicate complications such as postpericardiotomy syndrome with tamponade 3, 4
A clinical examination should be performed to assess for signs of cardiac tamponade or other complications, as recommended by the American Heart Association 2
An ECG should be obtained to monitor for new-onset or recurrent arrhythmias, according to the American Heart Association 4, 2

The American College of Cardiology recommends that Transthoracic Echocardiography (TTE) is the primary imaging modality for POD 1 evaluation and is rated as "Appropriate" 1
TTE assessment should include device position and stability, presence of residual shunting, evidence of thrombus formation on the device, evaluation for pericardial effusion or tamponade, assessment of pulmonary artery pressure, right ventricular size and function, and tricuspid valve function, as recommended by the American Heart Association 2, 5

The American Heart Association recommends a follow-up schedule of 1 month post-procedure 2, 5
The American College of Cardiology and American Heart Association recommend follow-up at 3-6 months post-procedure 1, 2
The American College of Cardiology and American Heart Association recommend follow-up at 1 year post-procedure 1, 2
The European Society of Cardiology recommends periodic follow-up thereafter (typically every 2-4 years) 6

The American Heart Association recommends more frequent follow-up for patients with pulmonary arterial hypertension (PAH) 3, 4
The American Heart Association recommends more frequent follow-up for patients with atrial arrhythmias 3, 4
The American Heart Association recommends more frequent follow-up for patients with right or left ventricular dysfunction 3, 4
The American Heart Association recommends more frequent follow-up for patients with coexisting valvular or other cardiac lesions 3, 4
The American Heart Association recommends more frequent follow-up for patients with ASD repair performed in adulthood 3, 2

The American Heart Association warns that pericardial effusions and cardiac tamponade may develop up to several weeks after ASD closure, so patients and primary care physicians should be instructed to report concerning symptoms promptly 2, 5
The American Heart Association notes that device erosion, while rare, is a serious complication that may present with chest pain or syncope and requires urgent evaluation 4, 2
The American Heart Association recommends endocarditis prophylaxis for the first 6 months after ASD closure but not thereafter unless there are other indications 5