title: Transcatheter device closure of atrial septal defects in patients older than 60 years of age: immediate and follow-up results.
abstract: Atrial septal defect (ASD) closure reduces symptoms and prevents ongoing congestive heart failure. However, little is known about device closure in the elderly (age > 60 years) and whether it is a safe and effective treatment. In this study, we report our results with ASD transcatheter closure in the elderly patient > 60 years of age using the Amplatzer Septal Occluder (ASO) device.
  
  
  METHODS
  Between September 1999 and March 2007, a total of 41 patients (24 females and 17 males) who were > 60 years of age (range 62-87.2 years) and had indications for ASD closure (right ventricular enlargement, clinically symptomatic dyspnea, fatigue, palpitations, exercise intolerance, transient ischemic attacks and/or stroke) underwent an attempt of transcatheter device closure using the ASO.
  
  
  RESULTS
  The median Qp/Qs ratio was 2.3 (range 1-7.5). The median mean pulmonary artery pressure was 26 mmHg (range 11-52 mmHg). The median size of the ASD as measured by intracardiac echocardiography (ICE) (n = 38) or transesophageal echocardiography (TEE) (n = 3) was 18.9 mm (range 8-40 mm), and the median balloon-stretched (stop-flow technique) diameter (n = 32) was 23.5 mm (range 12-40 mm). The procedure was successful in all patients. 44 devices were deployed in the 41 patients (3 patients received 2 devices each). A 6 mm fenestration was created in a 30 mm device that was placed in 2 patients with left ventricle diastolic dysfunction. The median fluoroscopy time was 10 minutes (range 4-24.8 minutes), and the median procedure time was 60 minutes (range 26-110 minutes). Complications encountered during or within 24 hours after the procedure included: hematoma at the site of catheter insertion in 4 patients, small pericardial effusion in 5, and in 1 patient, the pacemaker lead was dislodged requiring reimplantation. The complete closure rate as assessed by ICE or TEE immediately after the procedure was 82%. However, complete closure, as assessed by transthoracic echocardiography at 24 hours and 6-24 months postintervention, was 82% and 97%, respectively. Two patients did not return for follow up and 4 patients were known to have expired for reasons unrelated to their ASD closure. At a median interval of 6 months after closure, the right ventricular end-diastolic dimension decreased from 38.9 +/- 9 mm preprocedure to 26.6 +/- 7 mm (p < 0.001; n = 31) postprocedure, and 89% of the patients showed improvement in symptoms. On a median follow-up interval of 28 months (range 6-79 months), 1 patient was noted to have a femoral pseudoaneurysm. Patients were doing well with no major clinical events.
  
  
  CONCLUSIONS
  In patients older than 60 years of age, device closure of ASDs is safe and an effective alternative to surgery. Right-heart remodeling can occur in patients > 60 years of age.
authors.affiliation: Department of Pediatrics, University of Chicago Comer Children's Hospital, Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: Huda
authors.initials: H
authors.lastname: Elshershari
authors.forename: Qi-Ling
authors.initials: QL
authors.lastname: Cao
authors.forename: Ziyad M
authors.initials: ZM
authors.lastname: Hijazi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography