title: 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.
abstract: Percutaneous closure of an atrial septal defect (ASD) in the elderly with reduced diastolic elasticity of the left ventricle poses a significant management challenge. We report on the case of an 85-year-old patient who was admitted for percutaneous device closure of a moderately large secundum atrial septal defect. Hemodynamic evaluation documented an increase in left atrial pressure from a mean of 12 mm Hg to a mean of 32 mm Hg after balloon test occlusion of the ASD. Two months later, after adequate pretreatment with diuretics and afterload-reducing substances, he underwent successful closure of the ASD using a self-fabricated fenestrated Amplatzer septal occluder, which resulted in a postimplantation left atrial pressure of a mean of 18 mm Hg. Recovery was unremarkable and the fenestration has remained patent for 3 months since implantation of the device. This unique case highlights the feasibility of using a self-fabricated fenestrated Amplatzer septal occluder to close interatrial communications in elderly patients with diastolic dysfunction of the left ventricle.
authors.affiliation: Section of Cardiology, Department of Pediatrics, University of Chicago Children's Hospital, IL 60637, USA.
authors.forename: Ralf
authors.initials: R
authors.lastname: Holzer
authors.forename: Qi-Ling
authors.initials: QL
authors.lastname: Cao
authors.forename: Ziyad M
authors.initials: ZM
authors.lastname: Hijazi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods; D003971:Diastole / Q000502:physiology; D018618:Echocardiography, Doppler, Color; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D019736:Prostheses and Implants; D011474:Prosthesis Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*