title: The benefit of atrial septal defect closure in elderly patients.
abstract: OBJECTIVE
  Closure of an atrial septal defect in elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defects (ASDs) in elderly patients.
  
  
  METHODS
  From a total of 488 patients with ASDs who underwent transcatheter closure, 75 patients aged over 60 years (45 female, 30 male) with a mean age of 65.3±15.7 (60-75) years were analyzed. All patients had an isolated secundum ASD with a mean pulmonary blood flow:systemic blood flow of 2.84±1.9 (1.5-3.9). Symptom-limited treadmill exercise tests with respiratory gas-exchange analysis and transthoracic color Doppler echocardiographic study, as well as quality of life measured using the Short Form (36) Health Survey (SF-36) were repeated in all patients before the procedure and after 12 months of follow-up.
  
  
  RESULTS
  The atrial septal device was successfully implanted in all patients (procedure time 37.7±4.5 [13-59] minutes, fluoroscopy time 11.2±9.9 [6-40] minutes). There were no major complications. The defect echo diameter was 17.7±15.8 (12-30) mm. The mean balloon-stretched diameter of ASDs was 22.4±7.9 (14-34) mm. The diameter of the implanted devices ranged from 16 to 34 mm. Significant improvement of exercise capacity was noted at 6 and 12 months after the procedure. Exercise time within 6 months of ASD closure was longer (P<0.001) compared to baseline values, and also oxygen consumption increased (P<0.001). Seven quality-of-life parameters (except mental health) improved at 12-month follow-up compared to baseline data. The mean SF-36 scale increased significantly in 66 (88%) patients, with a mean of 46.2±19.1 (5-69). As early as 1 month after the procedure, a significant decrease of the right ventricular dimension and the right atrium dimension was observed (P<0.001). The right ventricular dimension decreased in 67 patients (89.3%).
  
  
  CONCLUSIONS
  Closure of ASDs in elderly patients caused significant clinical and hemodynamic improvement after percutaneous treatment, which was maintained during long-term follow-up, justifying this procedure in old age.
authors: Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors: Monika
authors: M
authors: Komar
authors: Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors: Tadeusz
authors: T
authors: Przewlocki
authors: Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors: Maria
authors: M
authors: Olszowska
authors: Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors: Bartosz
authors: B
authors: Sobien
authors: Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland.
authors: Piotr
authors: P
authors: Podolec
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D006328:Cardiac Catheterization; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: atrial septal defect; cardiopulmonary exercise test; elderly; quality of life; transcatheter closure