Table 2. Indications for ASD Closure.

Indication for ASD Closure	AHA/ACC Recommendation
RA and RV enlargement, with or without symptoms	Class I
Paradoxical embolism	Class IIa
Platypnea-orthodeoxia	Class IIa
Net left-to-right shunt (Qp/Qs >1)	Class IIb
Pulmonary artery pressure <2/3 systemic pressure	Class IIb
PVR <2/3 systemic vascular resistance	Class IIb
Elevated pulmonary pressures or pulmonary vascular resistance but reversible with pulmonary vasodilator or transient percutaneous test occlusion (percutaneous test occlusion may not be possible for superior sinus venosus defect)	Class IIb
Severe, irreversible pulmonary hypertension	Class III
No evidence of left-to-right shunt	Class III

ACC indicates American College of Cardiology; AHA, American Heart Association; ASD, atrial septal defect; PVR, pulmonary vascular resistance; RA, right atrial; and RV, right ventricular. Adapted from Warnes et al.¹