title: Transcatheter device closure of atrial septal defects in patients above age 60.
abstract: BACKGROUND
  Closure of an atrial septal defect (ASD) mostly causes reverse remodelling of the right heart, a decrease in pulmonary artery pressures (PASP), and improves functional capacity. However, abolition of the left-to-right shunt may be unfavourable in older patients. This study aimed at evaluating patients older than 60 years who underwent ASD closure.
  
  
  RESULTS
  Forty-seven patients (mean age 69 5 years, 19.1% male) with ASD type secundum who underwent transcatheter device closure were included. Echocardiographic data before and after closure were obtained. Follow-up data until the last follow-up visit were retrieved. Age-, gender- and BMI-matched controls were selected. Before closure, ASD patients had a higher right ventricular end-diastolic diameter (RVEDD), right (RA) and left atrial (LA) dimensions, and PASP when compared to controls. After closure, RVEDD and PASP decreased whereas LVEDD and E/A-ratio increased. RVEDD, PASP, LA dimensions, left ventricular ejection fraction (LVEF) and E/A-ratio were higher than controls. NYHA class improved significantly after ASD-closure. During a median follow-up time of 3.3 years, 6 patients died and 16 were hospitalized because of cardiac events.
  
  
  CONCLUSIONS
  Device closure in the elderly improved functional capacity, with a decrease, but not a normalization of RV dimensions and PASP, and an increase in LV dimensions, EF and mitral E/A-ratio. Atrial arrhythmias and coronary ischaemic events are common in this population.
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Ströker
authors.forename: Alexander
authors.initials: A
authors.lastname: Van De Bruaene
authors.forename: Pieter
authors.initials: P
authors.lastname: De Meester
authors.forename: Kristien
authors.initials: K
authors.lastname: Van Deyck
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003971:Diastole / Q000502:physiology; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016277:Ventricular Function, Left / Q000502:physiology