Device closure of ASD in older patients

Generally closure of atrial septal defect (ASD) is done in children and young adults. Benefits of device closure of ASD in older patients are not well documented. A recent study involving 23 patients with ASD and aged 50 – 91 years, having ASD size between 16 to 36 mm reported favorable cardiac remodeling and improvement of functional class. The NYHA (New York Heart Association) functional class improved in 16 patients. They had significant improvement in 6 minute walk distance and mental health score. No major complications were noted in these ASD device recipients. They also had significant change in the left ventricular end diastolic and end systolic dimensions at one year after the closure. There was accompanying significant reduction in right ventricular end diastolic dimensions as expected. The improvement of left ventricular function was due to offsetting of the reverse Bernheim effect in which right ventricular dilatation causes a septal bulge and impedance to left ventricular function. Though some studies have shown transient increases in left atrial pressure and consequent pulmonary edema in elderly patients after ASD closure, due to a stiff left ventricle, the current study did not report any such instance. The authors concluded that ASD closure with devices is technically feasible and is associated with favourable cardiac remodeling and improvement in functional class in older patients.

Leave a Reply