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The Impact of Transcatheter Atrial Septal Defect Closure in the Older Population

A Prospective Study

Arif Anis Khan, MD^_*,_*, Ju-Le Tan, MD^_*,, W. Li, PhD^_*, Kostas Dimopoulos, MD, PhD^_*, Mark S. Spence, MD^_*,, Pak Chow, MD^_*,, Michael J. Mullen, MD^_*

^_* Royal Brompton Hospital, London, United Kingdom
National Heart Centre Singapore, Mistri Wing, Singapore
Royal Victoria hospitals, Belfast, Ireland
Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China

^_* Reprint requests and correspondence: Dr. Arif Anis Khan, MD, FCPS, Adult Congenital Heart Disease Unit, Cardiology Department, Royal Brompton Hospital, Sydney Street, SW3 6NP London, United Kingdom (Email: Arif.Khan{at}rbh.nthames.nhs.uk).

Objectives: We sought to prove that device closure of atrial septal defect (ASD) in older patients not only improves cardiac function but also results in symptomatic relief by improving functional class.

Background: Atrial septal defect accounts for approximately 10% of all congenital cardiac defects. It is possible that ASD closure in older patients may derive benefits, though this is not well established. We therefore aim to prospectively assess the clinical status and functional class of older patients after transcatheter ASD closure.

Methods: This was a prospective study of all patients age 40 years or more who underwent device closure of a secundum ASD between April 2004 and August 2006. Investigations including atrial and brain natriuretic peptide levels, electrocardiography, chest X-ray, transthoracic echocardiogram, 6-min walk test, and quality of life questionnaire were performed before and at 6 weeks and 1 year after the procedure.

Results: Twenty-three patients (median age 70 years, 13 women) had transcatheter device closure of ASD. Median ASD size was 18 mm (range 9 to 30 mm). Median pulmonary artery pressure was 22 mm Hg (range 12 to 27 mm Hg). At 1 year, New York Heart Association functional class improved (p = 0.004) in 16 patients with significant improvement in 6-min walk-test distance (p = 0.004) and physical (p = 0.002) as well as mental health score (p = 0.03). There were no major complications. One year following closure there was a significant change in left ventricular end-diastolic (p = 0.001) and end-systolic dimensions (p = 0.001) and also significant reduction in right ventricular end-diastolic dimension (p < 0.001).

Conclusions: Our data demonstrated that ASD closure at advanced age results in favorable cardiac remodeling and improvement of functional class.

Key Words: atrial septal defect • transcatheter closure

Abbreviations and Acronyms   6MWT = 6-min walk test   ASD = atrial septal defect   DTI = Doppler tissue imaging   LV = left ventricle   NYHA = New York Heart Association   QOL = quality of life   RV = right ventricle