Korean Circ J.  2013 Feb;43(2):110-114. 10.4070/kcj.2013.43.2.110.

Transcatheter Closure of Secundum Atrial Septal Defect in Patients Over 60 Years Old

• Woo SB
• Jang SI
• Kim SH
• Kim SJ
• Lee SY
• Baek JS
• Shim WS

• KMID: 1769646
• DOI: http://doi.org/10.4070/kcj.2013.43.2.110

Abstract

BACKGROUND AND OBJECTIVES
Atrial septal defect (ASD) is the one of most common congenital heart diseases detected in adults. Along with remarkable development of device technology, the first treatment strategy of secundum ASD has been transcatheter closure in feasible cases. However, there are only a few publications regarding the results of transcatheter closure of ASD in elderly patients, especially those over 60 years of age. We report our results of transcatheter closure of ASD in patients over 60 years old.
SUBJECTS AND METHODS
Between May 2006 and December 2011, 31 patients over 60 years old (25 female and 6 male; mean 66.7+/-5.25 years old, range 61-78 years old) were referred to our center.
RESULTS
A total of 23 patients underwent therapeutic catheterization to close secundum ASD, and the closure was successful in 22 patients (95.7%). All patients who underwent the procedure survived except for one patient who expired because of left ventricular dysfunction. A small residual shunt was observed in two (9%) of 21 patients before discharge but disappeared at follow-up. All patients eventually had complete closure. There were five patients who had coronary problems. One patient underwent percutaneous coronary intervention using a stent at the same time as transcatheter closure of ASD. Atrial arrhythmias were detected in 6 of 23 patients (26.1%) before the procedure. One patient was successfully treated by radiofrequency ablation before the procedure. No patients displayed new onset arrhythmia during the follow-up period. Follow-up echocardiographic evaluation showed a significantly improved right ventricular geometry.
CONCLUSION
We conclude that transcatheter closure of ASD is a safe and an effective treatment method for patients over 60 years old if the procedure is performed under a thorough evaluation of comorbidities and risk factors.

Keyword

Atrial septal defect; Septal occluder device; Elderly

MeSH Terms

Adult
Aged
Arrhythmias, Cardiac
Catheterization
Catheters
Comorbidity
Female
Follow-Up Studies
Heart Diseases
Heart Septal Defects, Atrial
Humans
Percutaneous Coronary Intervention
Risk Factors
Septal Occluder Device
Stents
Ventricular Dysfunction, Left

Reference

1. Podnar T, Martanovic P, Gavora P, Masura J. Morphological variations of secundum-type atrial septal defects: feasibility for percutaneous closure using Amplatzer septal occluders. Catheter Cardiovasc Interv. 2001. 53:386–391.

2. Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K. Amplatzer Investigators. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol. 2002. 39:1836–1844.

3. Masura J, Gavora P, Podnar T. Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders. J Am Coll Cardiol. 2005. 45:505–507.

4. Boutin C, Musewe NN, Smallhorn JF, Dyck JD, Kobayashi T, Benson LN. Echocardiographic follow-up of atrial septal defect after catheter closure by double-umbrella device. Circulation. 1993. 88:621–627.

5. Murphy JG, Gersh BJ, McGoon MD, et al. Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med. 1990. 323:1645–1650.

6. Harjula A, Kupari M, Kyösola K, et al. Early and late results of surgery for atrial septal defect in patients aged over 60 years. J Cardiovasc Surg (Torino). 1988. 29:134–139.

7. Konstantinides S, Geibel A, Olschewski M, et al. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med. 1995. 333:469–473.

8. Miyaji K, Furuse A, Tanaka O, Kubota H, Ono M, Kawauchi M. Surgical repair for atrial septal defect in patients over 70 years of age. Jpn Heart J. 1997. 38:677–684.

9. Attie F, Rosas M, Granados N, Zabal C, Buendía A, Calderón J. Surgical treatment for secundum atrial septal defects in patients >40 years old. A randomized clinical trial. J Am Coll Cardiol. 2001. 38:2035–2042.

10. Schubert S, Peters B, Abdul-Khaliq H, Nagdyman N, Lange PE, Ewert P. Left ventricular conditioning in the elderly patient to prevent congestive heart failure after transcatheter closure of atrial septal defect. Catheter Cardiovasc Interv. 2005. 64:333–337.

11. Swan L, Varma C, Yip J, et al. Transcatheter device closure of atrial septal defects in the elderly: technical considerations and short-term outcomes. Int J Cardiol. 2006. 107:207–210.

12. Spies C, Hijazi ZM. Transcatheter closure of secundum atrial septal defects in the elderly. Korean Circ J. 2009. 39:47–51.

13. Giardini A, Donti A, Sciarra F, Bronzetti G, Mariucci E, Picchio FM. Long-term incidence of atrial fibrillation and flutter after transcatheter atrial septal defect closure in adults. Int J Cardiol. 2009. 134:47–51.

14. Taniguchi M, Akagi T, Ohtsuki S, et al. Transcatheter closure of atrial septal defect in elderly patients with permanent atrial fibrillation. Catheter Cardiovasc Interv. 2009. 73:682–686.

15. Ewert P, Berger F, Nagdyman N, et al. Masked left ventricular restriction in elderly patients with atrial septal defects: a contraindication for closure? Catheter Cardiovasc Interv. 2001. 52:177–180.

16. Elshershari H, Cao QL, Hijazi ZM. Transcatheter device closure of atrial septal defects in patients older than 60 years of age: immediate and follow-up results. J Invasive Cardiol. 2008. 20:173–176.

17. Kim NK, Park SJ, Choi JY. Transcatheter closure of atrial septal defect: does age matter? Korean Circ J. 2011. 41:633–638.

18. Holzer R, Hijazi ZM. Interventional approach to congenital heart disease. Curr Opin Cardiol. 2004. 19:84–90.

19. Beyer J. Atrial septal defect: acute left heart failure after surgical closure. Ann Thorac Surg. 1978. 25:36–43.

20. Koenig P, Cao QL, Heitschmidt M, Waight DJ, Hijazi ZM. Role of intracardiac echocardiographic guidance in transcatheter closure of atrial septal defects and patent foramen ovale using the Amplatzer device. J Interv Cardiol. 2003. 16:51–62.

21. Zanchetta M, Onorato E, Rigatelli G, et al. Intracardiac echocardiography-guided transcatheter closure of secundum atrial septal defect: a new efficient device selection method. J Am Coll Cardiol. 2003. 42:1677–1682.

22. Chessa M, Carminati M, Butera G, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol. 2002. 39:1061–1065.