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Masked left ventricular restriction in elderly patients with atrial septal defects: a contraindication for closure?

P Ewert1, F Berger, N Nagdyman

  • 1Abteilung für angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany. ewert@dhzb.de

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 15, 2001
PubMed

Insights

Atrial septal defects in older adults may relieve left ventricular pressure. Closing these defects requires caution, as it can lead to heart failure in the elderly.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Cardiovascular Physiology

Background:

  • Elderly individuals often have reduced left ventricular diastolic elasticity.
  • The hemodynamic impact of atrial septal defects (ASDs) in this population is not well understood.

Purpose of the Study:

  • To investigate the hemodynamic effects of temporary balloon occlusion of ASDs in patients over 60 years of age.
  • To assess the impact of relieving the left-to-right shunt on left ventricular filling pressures and dynamics.

Main Methods:

  • Eighteen patients aged over 60 underwent balloon occlusion of their ASD.
  • Left atrial pressure and mitral valve inflow (E/A ratio) were measured during occlusion and after deflation.

Main Results:

  • Seven patients showed a significant increase in left atrial pressure (mean 27 mm Hg, v-wave peak 55 mm Hg) and E/A ratio during occlusion (P = 0.02).
  • Two patients who underwent transcatheter device closure subsequently developed congestive heart failure.

Conclusions:

  • In elderly patients with reduced left ventricular diastolic function, an atrial septal defect may serve a decompressive role.
  • Intervention for ASD closure in this demographic warrants careful consideration due to potential adverse hemodynamic consequences.

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