Mavroudis Supplement
Congenital Heart Surgery Nomenclature and Database Project: atrial septal defect

Presented at the International Nomenclature and Database Conferences for Pediatric Cardiac Surgery, 1998–1999.
https://doi.org/10.1016/S0003-4975(99)01233-3Get rights and content

Abstract

The extant nomenclature for atrial septal defect (ASD) is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories using synonyms where appropriate. A comprehensive database set is presented that is based on a hierarchical scheme. Data are entered at various levels of complexity and detail that can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented that will allow for data sharing and would lend itself to basic interpretation of trends. Outcome tables relating diagnoses, procedures, and various risk factors are presented.

Section snippets

Background

An atrial septal defect (ASD) is defind as an opening or hole in the interatrial septum. ASD nomenclature is less controversial than ventricular septal defect (VSD) nomenclature. ASD nomenclature is based upon knowledge of the developmental anatomy of the atrial septum [1].

In utero, systemic veins drain into the sinus venosus and then the primitive atrium [2]. As the atrium develops, the thin septum primum forms the initial atrial septum and obliterates the foramen primum. The foramen secundum

ASD hierarchy level 1

  • ASD

ASD hierarchy level 1 definitions

ASD: An opening or hole in the interatrial septum

ASD hierarchy level 2

  • ASD, NOS

  • ASD, Common atrium (single atrium)

  • ASD, Coronary sinus (unroofed coronary sinus)

  • ASD, Patent foramen ovale

  • ASD, Primum

  • ASD, Secundum

  • ASD, Sinus venosus

ASD, NOS (not otherwise stated)

This designation allows for patient entries from other database schemes if no specific subtype is characterized or assigned.

ASD, common atrium (single atrium)

Complete absence of the interatrial septum [3]. The term “single atrium” has been applied to defects with complete absence of the atrial septum and absence of

ASD hierarchy level 3

  • ASD, NOS

  • ASD, Common atrium (single atrium)

  • ASD, Coronary sinus (unroofed coronary sinus)

  • ASD, PFO

  • ASD, Primum, NOS

  • ASD, Primum, Cleft mitral valve

  • ASD, Primum, No cleft mitral valve

  • ASD, Secundum, NOS

  • ASD, Secundum, Fenestrated

  • ASD, Secundum, Nonfenestrated

  • ASD, Sinus venosus, NOS

  • ASD, Sinus venosus, SVC type

  • ASD, Sinus venosus, IVC type

ASD, secundum, fenestrated; ASD, secundum, nonfenestrated

These variables are important as we record data on the closure of secundum ASDs by both surgical and interventional cardiology approaches.

ASD hierarchy level 4

  • ASD, NOS

  • ASD, Common atrium (single atrium)

  • ASD, Coronary sinus (unroofed coronary sinus)

  • ASD, PFO

  • ASD, Primum, NOS

  • ASD, Primum, Cleft mitral valve

  • ASD, Primum, No cleft mitral valve

  • ASD, Secundum, NOS

  • ASD, Secundum, Fenestrated, NOS

  • ASD, Secundum, Fenestrated, Two holes

  • ASD, Secundum, Fenestrated, Multiple holes

  • ASD, Secundum, Nonfenestrated

  • ASD, Sinus venosus, NOS

  • ASD, Sinus venosus, SVC type, NOS

  • ASD, Sinus venosus, SVC type, No partial anomalous pulmonary venous return (PAPVR)

  • ASD, Sinus venosus, SVC

ASD, sinus venosus, SVC type, NOS; ASD, sinus venosus, SVC type, No PAPVR; ASD, sinus venosus, SVC type, PAPVR; ASD, sinus venosus, IVC type, NOS; ASD, sinus venosus, IVC type, No PAPVR; ASD, sinus venosus, IVC type, PAPVR

Obviously, sinus venosus ASD is associated with PAPVR. This level 4 hierarchy allows this association to be coded directly. The specific type of PAPVR can then be coded and described in detail separately under PAPVR. The PAPVR section of this coding system will allow for detailed coding of the specific PAPVR type, including PAPVR seen with sinus venosus ASD, other types of ASD, and without associated ASD, including the Scimitar syndrome.

Additional modifiers for ASD: hierarchy level 1

  • ASD, Persistent (Postoperative intentional)

  • ASD Previously created (Iatrogenic)

  • ASD, Residual

ASD, persistent (postoperative intentional)

Any ASD that was intentionally left open at a previous operation.

ASD, previously created (iatrogenic)

Any ASD that was surgically created at a previous operation or intervention.

ASD, residual

Any ASD that had attempted closure or was missed at the time of prior surgery or intervention.

Additional modifiers for ASD: hierarchy level 2

  • ASD, Persistent (postoperative intentional)

  • ASD, Previously created (iatrogenic), NOS

  • ASD, Previously created (iatrogenic), Adjustable ASD

  • ASD, Previously created (iatrogenic), Balloon septostomy

  • ASD, Previously created (iatrogenic), Blade septostomy

  • ASD, Previously created (iatrogenic), Blalock-Hanlon

  • ASD, Previously created (iatrogenic), surgically created atrial fenestration

  • ASD Residual, NOS

  • ASD Residual, After surgery

  • ASD, Residual, After occlusion device

ASD treatment hierarchy level 1

  • ASD creation

  • ASD enlargement

  • ASD partial closure

  • Atrial septal fenestration

  • ASD repair

ASD treatment hierarchy level 2

  • ASD creation, NOS

  • ASD creation, Adjustable ASD

  • ASD creation, Balloon septostomy

  • ASD creation, Blade septostomy

  • ASD creation, Atrial septectomy

  • ASD enlargement

  • ASD partial closure

  • Atrial septal fenestration

  • ASD repair, NOS

  • ASD repair, Common atrium (single atrium) septation

  • ASD repair, Coronary sinus (unroofed coronary sinus)

  • ASD repair, PFO

  • ASD repair, Primum

  • ASD repair, Secundum

  • ASD repair, Sinus venosus

  • ASD repair, Closure of

Diagnosis and procedure short lists

  • Diagnosis Short List

  • ASD, NOS

  • PFO

  • ASD, Secundum

  • ASD, Sinus venosus

  • ASD, Common atrium (single atrium)

  • ASD, Coronary sinus

  • Procedure Short List

  • ASD repair, Patch

  • ASD repair, Primary closure

  • ASD repair, Device

  • ASD creation/enlargement

  • ASD partial closure

  • ASD repair, Common atrium, (Single atrium) septation

  • Atrial septal fenestration

  • PFO, Primary closure

Potential diagnostic-related risk factors

In addition to the common data fields utilized in the minimal data set and comprehensive data set applicable to all lesions, specific data fields to be tracked for ASD include the following data fields.

Atrial arrhythmias after “ASD repair, sinus venosus,” comparing the incidence of atrial arrhythmias such as sinus node dysfunction with the various repair types including

  • ASD repair, Sinus venosus, ASD patch

  • ASD repair, Sinus venosus, ASD patch and SVC patch

  • ASD repair, Sinus venosus, Warden (SVC

ASD: inclusion criteria and allowable concomitant diagnoses

A case is included for ASD analysis if the primary diagnosis is ASD and concomitant cardiac diagnoses are none, left superior vena cava, PDA, or any combination of these. If no ASD subtype is given, the ASD will be classified as ASD, NOS.

ASD surgery type (by year)

This table will show the number and percentage of each major ASD type (according to ASD hierarchy level 2) for each year. (If no ASD subtype is given, the ASD will be classified as ASD, NOS.) (Lesions coded as “ASD, primum” or any subtypes of “ASD, primum” will

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