Clinical Research
The Impact of Transcatheter Atrial Septal Defect Closure in the Older Population: A Prospective Study

https://doi.org/10.1016/j.jcin.2009.12.011Get rights and content
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Objectives

We sought to prove that device closure of atrial septal defect (ASD) in older patients not only improves cardiac function but also results in symptomatic relief by improving functional class.

Background

Atrial septal defect accounts for approximately 10% of all congenital cardiac defects. It is possible that ASD closure in older patients may derive benefits, though this is not well established. We therefore aim to prospectively assess the clinical status and functional class of older patients after transcatheter ASD closure.

Methods

This was a prospective study of all patients age 40 years or more who underwent device closure of a secundum ASD between April 2004 and August 2006. Investigations including atrial and brain natriuretic peptide levels, electrocardiography, chest X-ray, transthoracic echocardiogram, 6-min walk test, and quality of life questionnaire were performed before and at 6 weeks and 1 year after the procedure.

Results

Twenty-three patients (median age 70 years, 13 women) had transcatheter device closure of ASD. Median ASD size was 18 mm (range 9 to 30 mm). Median pulmonary artery pressure was 22 mm Hg (range 12 to 27 mm Hg). At 1 year, New York Heart Association functional class improved (p = 0.004) in 16 patients with significant improvement in 6-min walk-test distance (p = 0.004) and physical (p = 0.002) as well as mental health score (p = 0.03). There were no major complications. One year following closure there was a significant change in left ventricular end-diastolic (p = 0.001) and end-systolic dimensions (p = 0.001) and also significant reduction in right ventricular end-diastolic dimension (p < 0.001).

Conclusions

Our data demonstrated that ASD closure at advanced age results in favorable cardiac remodeling and improvement of functional class.

Key Words

atrial septal defect
transcatheter closure

Abbreviations and Acronyms

6MWT
6-min walk test
ASD
atrial septal defect
DTI
Doppler tissue imaging
LV
left ventricle
NYHA
New York Heart Association
QOL
quality of life
RV
right ventricle

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