Korean Circ J.  2009 Feb;39(2):47-51. 10.4070/kcj.2009.39.2.47.

Transcatheter Closure of Secundum Atrial Septal Defects in the Elderly

• Spies C
• Hijazi ZM

• KMID: 2297948
• DOI: http://doi.org/10.4070/kcj.2009.39.2.47

Abstract

BACKGROUND AND OBJECTIVES
With the exception of bicuspid aortic valves, atrial septal defects (ASDs) are the most common congenital heart lesions found in adults. A mortality and morbidity benefit has clearly been demonstrated in the treatment of this lesion in younger patients. However, the benefits of ASD closure are less well defined in the elderly. We report our experience with transcatheter ASD closure and detail its impact on functional status and right ventricular remodeling as indicators of right heart failure in patients greater than 60 years of age.
SUBJECTS AND METHODS
Fifty-five patients (median age 70 years) underwent ASD closure at a single center during an eight-year period. Data were collected and analyzed retrospectively.
RESULTS
Transcatheter closure was successful in all patients. No major complications occurred during the periprocedural or follow-up periods. Complete defect closure was documented in 97% of patients during follow-up. All patients improved by at least one New York Heart Association (NYHA) functional class. Following ASD closure, no patient was in NYHA III or IV. The median right-ventricular end-diastolic diameter decreased from 39 mm to 26.6 mm (p<0.001).
CONCLUSION
Atrial septal defect closure is safe and effective in elderly patients. Our data and prior published data consistently demonstrate that even patients greater than 60 years of age experience improvement in functional status and right ventricular remodeling. Therefore, patient age should not influence the decision of whether an ASD should be closed.

Keyword

Congenital heart disease; Atrial septal defect; Aged

MeSH Terms

Adult
Aged
Aortic Valve
Bicuspid
Follow-Up Studies
Heart
Heart Failure
Heart Septal Defects, Atrial
Humans
New York
Retrospective Studies
Ventricular Remodeling

Figure

• 

  Fig. 1 Serial changes in right ventricular end-diastolic diameter before and after atrial septal defect closure. RVEDD: right ventricular end-diastolic diameter.

Reference

1. Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K. 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.

2. Fischer G, Stieh J, Uebing A, Hoffmann U, Morf G, Kramer HH. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart. 2003. 89:199–204.

3. Spies C, Timmermanns I, Schrader R. Transcatheter closure of secundum atrial septal defects in adults with the Amplatzer septal occluder: intermediate and long-term results. Clin Res Cardiol. 2007. 96:340–346.

4. 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.

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. Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med. 1999. 340:839–846.

7. 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.

8. Jemielity M, Dyszkiewicz W, Paluszkiewicz L, Perek B, Buczkowski P, Ponizynski A. Do patients over 40 years of age benefit from surgical closure of atrial septal defects? Heart. 2001. 85:300–303.

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

10. 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.

11. Hijazi ZM. Catheter closure of atrial septal and ventricular septal defects using the Amplatzer devices. Heart Lung Circ. 2003. 12:Suppl 2. S63–S72.

12. Hijazi ZM, Cao Q, Patel HT, Rhodes J, Hanlon KM. Transesophageal echocardiographic results of catheter closure of atrial septal defect in children and adults using the Amplatzer device. Am J Cardiol. 2000. 85:1387–1390.

13. Harper RW, Mottram PM, McGaw DJ. Closure of secundum atrial septal defects with the Amplatzer septal occluder device: techniques and problems. Catheter Cardiovasc Interv. 2002. 57:508–524.

14. 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.

15. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008. 118:e714–e833.

16. Ghosh S, Chatterjee S, Black E, Firmin RK. Surgical closure of atrial septal defects in adults: effect of age at operation on outcome. Heart. 2002. 88:485–487.

17. 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.

18. Attie F, Rosas M, Granados N, Zabal C, Buendia A, Calderon 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.

19. Kort HW, Balzer DT, Johnson MC. Resolution of right heart enlargement after closure of secundum atrial septal defect with transcatheter technique. J Am Coll Cardiol. 2001. 38:1528–1532.

20. Du ZD, Cao QL, Koenig P, Heitschmidt M, Hijazi ZM. Speed of normalization of right ventricular volume overload after transcatheter closure of atrial septal defect in children and adults. Am J Cardiol. 2001. 88:1450–1453. A9

21. Fredriksen PM, Veldtman G, Hechter S, et al. Aerobic capacity in adults with various congenital heart diseases. Am J Cardiol. 2001. 87:310–314.

22. Diller GP, Dimopoulos K, Okonko D, et al. Exercise intolerance in adult congenital heart disease: comparative severity, correlates, and prognostic implication. Circulation. 2005. 112:828–835.

23. Veldtman GR, Razack V, Siu S, et al. Right ventricular form and function after percutaneous atrial septal defect device closure. J Am Coll Cardiol. 2001. 37:2108–2113.

24. Holzer R, Cao QL, Hijazi ZM. Closure of a moderately large atrial septal defect with a self-fabricated fenestrated Amplatzer septal occluder in an 85-year-old patient with reduced diastolic elasticity of the left ventricle. Catheter Cardiovasc Interv. 2005. 64:513–518.

25. Spies C, Khandelwal A, Timmermanns I, Schrader R. Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults. Am J Cardiol. 2008. 102:902–906.