Mavroudis SupplementCongenital Heart Surgery Nomenclature and Database Project: atrial septal defect
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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