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Updated: May 21, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Percutaneous device closure of secundum atrial septal defect in older adults
Hossein Dehghani1, Andrew J Boyle
1Department of Medicine, Division of Cardiology, University of California San Francisco San Francisco, CA, USA.
Insights
Closing atrial septal defects (ASDs) percutaneously benefits adults, improving heart function and symptoms. Early closure of these common congenital heart defects is recommended upon diagnosis for optimal outcomes.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Ostium secundum atrial septal defect (ASD) is a frequent congenital heart anomaly.
- Percutaneous device closure is standard for pediatric and young adult ASDs.
- Emerging evidence suggests benefits of ASD closure extend to older adults.
Purpose of the Study:
- To review the literature on percutaneous device closure of ASDs in adult populations.
- To evaluate the benefits and optimal timing of ASD closure in older adults.
Main Methods:
- Literature review of studies on ASD closure in adults.
- Analysis of data on cardiac geometry, pulmonary pressures, symptoms, and exercise capacity post-closure.
- Assessment of potential impact on atrial arrhythmias.
Main Results:
- ASD closure in adults shows positive effects on cardiac chamber dimensions and pulmonary artery pressures.
- Patient symptoms and exercise capacity improve following percutaneous closure.
- Earlier closure appears to yield more pronounced salutary effects.
Conclusions:
- Percutaneous device closure of ASDs should be considered in adults upon diagnosis.
- Closure is recommended earlier rather than later, even before symptom onset or chamber dilatation.
- Further research is needed to confirm the impact on atrial arrhythmia development.
Abstract:
Ostium secundum atrial septal defect (ASD) is a common congenital heart defect. The adverse prognosis of untreated ASD diagnosed in childhood is well studied and percutaneous device closure of these ASDs has evolved to become the standard of care in both pediatric and young adult populations. There is a growing body of literature that suggests the benefits of ASD closure are not restricted to younger populations. In older adults, there are beneficial effects on cardiac chamber geometry, pulmonary artery pressures, patient symptoms and exercise capacity with closure of the ASD, and these salutary effects appear to be more pronounced the earlier the defect is closed. There may even be a reduction in the development of atrial arrhythmias, although this remains to be conclusively demonstrated. In this review, we summarize the literature regarding ASD closure in older adults. The weight of evidence suggests that ASD should be closed percutaneously earlier rather than later, and consideration should be given to percutaneous device closure of ASD in adults upon diagnosis, rather than waiting for symptoms or cardiac chamber dilatation.
