Transcatheter device closure is now the preferred approach for most secundum atrial septal defects (ASDs), and the evidence base continues to favor it over surgery in suitable anatomy. Meta-analyses in pediatric patients show fewer complications (notably arrhythmias and pericardial effusion) and shorter hospital stays with transcatheter closure than with surgical repair. The commonly used devices — the Amplatzer Septal Occluder and the Occlutech Figulla Flex II — are typically sized a few millimeters larger than the defect, and device migration is rare (well under 1% in registry data).
Two areas remain under active study. Iatrogenic ASDs created during other structural heart interventions (such as transseptal procedures) generally do not appear to benefit from percutaneous closure over conservative management, though spontaneous closure is associated with fewer heart-failure hospitalizations. And advanced imaging — cardiac MRI and intracardiac echocardiography — has improved both diagnosis and intra-procedural guidance.
Further reading: surgical versus transcatheter closure of pediatric secundum ASD (de Liyis et al., 2024); device and size selection from a Japanese nationwide registry (Tanaka et al., 2025); transcatheter closure of septal defects (Turner et al., JACC 2022).