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  • Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC Guidelines for the management of grown-up congenital heart disease. Eur Heart J. 2010;31:2915–2957.

Comprehensive reference from Europe.

  • Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease. Circulation. 2019;139:e698–e800.

Find the disorder in the table of contents. Read the synopsis.

  • Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease. Circulation. 2008;118:e714–e833.

Authoritative comprehensive reference. Written by experts in the field.

Echo Imaging References Source
  • Khraiche D, Ben Moussa N. Assessment of right ventricular systolic function by echocardiography after surgical repair of congenital heart defects. Arch Cardiovasc Dis. 2016;109:113–119.

Postoperative impairment of RV systolic function can appear after surgical repair of complex congenital heart defects, such as tetralogy of Fallot. It is caused by chronic volume and/or pressure overload due to pulmonary regurgitation and/or stenosis. RV dysfunction is strongly associated with prognosis in these patients.

  • Simpson J, Lopez L, Acar P, et al. Three-dimensional echocardiography in congenital heart disease. Eur Heart J Cardiovasc Imaging. 2016;17:1071–1097.

  • Sreedhar R. Acyanotic congenital heart disease and transesophageal echocardiography. Ann Card Anaesth. 2017;20(Supplement):S36–S42.

TEE findings in congenital heart defects.

  • Vettukattil JJ. Three-dimensional echocardiography in congenital heart disease. Heart. 2012;98:79–88.

Follow this author if you are interested in 3D printing of congenital heart defects.

See also:



  • It is important to understand the embryologic formation of the atrial septum.

  • There is a complex septation process that includes sequential tissue connections, as well as tissue reabsorption by programmed cell death.

  • The secundum atrial septal defect is actually a defect of the primum septum.

  • The primum septum grows to divide the originally single embryologic atrium into two atria.

  • At the same time, the endocardial cushions are growing to separate the atria from the ventricles.

  • The septum primum grows toward the endocardial cushions.

  • As the primum septum grows, fenestrations develop, creating the ostium secundum.

  • Tip: Easiest way to learn this is to watch a YouTube video on the embryology of the atrial septum.


  • Anderson RH, Brown NA, Webb S. Development and structure of the atrial septum. Heart. 2002;88:104–110.

  • Campbell M. Natural history of atrial septal defect. Br Heart J. 1970;32:820–826.

  • Craig RJ, Selzer A. Natural history and prognosis of atrial septal defect. Circulation. 1968;37:805–815.

  • Saxena A, Divekar A, Soni NR. Natural history of secundum atrial septal defect revisited in the era of transcatheter closure. Indian Heart J. 2005;57:35–38.

  • Webb G, Gatzoulis MA. Atrial septal defects in the adult: recent progress and overview. Circulation. 2006;114:1645–1653.

Secundum Atrial Septal Defect

  • A secundum atrial septal defect may be diagnosed for the first time in ...

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