The main indication for closing a secundum atrial septal defect (ASD) is a significant left-to-right shunt, with acceptable pulmonary vascular resistances.1 2 Transcatheter closure has become an accepted alternative to surgical repair for most types of ostium secundum ASD. The technique is commonly referred to for patients with a defect under 38 mm in diameter without deficient rims and allows safe and effective ASD closure in most unselected cases. The main limit for percutaneous closure is the size of the defect as well as the existence of appropriate rims.1–3 In many patients referred for transcatheter closure, the question is often ‘How large is too large?’3 In Dolgner et al ’s4 study, the above-mentioned statements are challenged after they report 10% of stroke in a selected study population of 346 patients with a secundum ASD and no known atrial arrhythmias. The authors provide a risk stratification based on the three following independent risk factors for this population: a body mass index >25, smoking and a prominent Eustachian valve. They conclude that ASD closure could be considered in this patient population, even without a significant left-to-right shunt.4 This study is remarkable because this is the …

中文翻译：

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关闭房间隔缺损以预防中风：多小是太小？

闭合继发孔房间隔缺损 (ASD) 的主要适应症是显着的左向右分流，肺血管阻力可接受。1 2 经导管闭合已成为大多数类型继发孔 ASD 手术修复的公认替代方案。该技术通常适用于直径小于 38 mm 且无边缘缺陷的患者，并且在大多数未选择的情况下可以安全有效地闭合 ASD。经皮闭合的主要限制是缺损的大小以及是否存在合适的边缘。 1-3 在许多转诊进行经导管闭合的患者中，问题通常是“多大才太大？”3 在 Dolgner 等人中s4学习，在 346 名患有继发性 ASD 且无已知房性心律失常的选定研究人群中，上述陈述报告了 10% 的卒中发生率后，上述陈述受到质疑。作者根据该人群的以下三个独立风险因素提供了风险分层：体重指数 >25、吸烟和突出的咽鼓瓣。他们得出的结论是，即使没有显着的左向右分流，也可以在该患者群体中考虑 ASD 闭合。4 这项研究非常出色，因为这是……