August 2015

Atrial septal communications account for approximately 6%–10% of congenital heart defects, with an incidence of 1 in 1,500 live births. The atrial septal defect (ASD) is among the most common acyanotic congenital cardiac lesions, occurring in 0.1% of births and accounting for 30%–40% of clinically important intracardiac shunts in adults. The patent foramen ovale (PFO) is more common and is present in greater than 20%–25% of adults. The clinical syndromes associated with ASD and PFO are extremely variable and represent a significant health burden that spans pediatric and adult medicine, neurology, and surgery. The evaluation of abnormalities of the interatrial septum and their associated syndromes require a standardized, systematic approach to their echocardiographic and Doppler characterization, including the use of transthoracic echocardiographic (TTE), transesophageal echocardiographic (TEE), and intracardiac echocardiographic (ICE) ultrasound, three-dimensional (3D) imaging, Doppler, and transcranial Doppler (TCD) modalities.