Historically, the evaluation of patients with suspected congenital heart disease relied heavily on the results of the physical exam and cardiac catheterization. In the current era, the initial assessment of congenital lesions can now be safely and easily accomplished with cardiac ultrasound, often without the need for further invasive testing. One of the most frequently encountered acyan-otic congenital lesions in clinical practice is the atrial septal defect (ASD), of which echocardiography provides invaluable information in the initial assessment, follow-up, and management. The spatial resolution of echocardiography allows for accurate classification of ASDs and a comprehensive evaluation of associated cardiac pathology. A quantification of shunt flow and hemodynamics can be easily accomplished with Doppler, and provide an objective means of follow up for these patients. Finally, echocardiography can be used to guide percutaneous closure of ASDs, providing an important avenue for minimally invasive intervention. Thus, echocardiography is currently the basis for the initial diagnosis, follow-up, and when appropriate, management of ASDs.

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