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ASD closure under pressure

Suhair Omar Shebani1, Gregory James Skinner1, Christopher Duke1

  • 1East Midlands Congenital Heart Centre, Leicester Hospitals NHS Trust, Leicester, Leicestershire, UK.

BMJ Case Reports
|September 13, 2014
PubMed

Insights

Transcatheter atrial septal defect device closure can be safe in elderly patients, even with a significant rise in left atrial pressure. This approach improved the patient's symptoms and functional status.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Transcatheter atrial septal defect (ASD) device implantation in elderly patients can precipitate acute pulmonary edema due to impaired left ventricular diastolic function.
  • A significant increase in left atrial pressure (LAP) during device implantation is a concern, but clear contraindication cut-off values for LAP are not established.

Observation:

  • This case report details the successful closure of an ASD in a 73-year-old patient.
  • The patient experienced a substantial increase in mean LAP from 18 to 25 mm Hg during device implantation, despite the use of a fenestrated device.
  • Post-procedure management included mechanical ventilation, milrinone, and diuretics, which prevented pulmonary edema.

Findings:

  • Successful transcatheter ASD device closure was achieved in an elderly patient with a significant LAP increase.
  • The patient demonstrated notable clinical improvement, with dyspnea resolving and functional status improving from New York Heart Association (NYHA) class III to II.

Implications:

  • This case suggests that successful ASD device closure is feasible even in the presence of elevated LAP in select elderly patients.
  • Careful patient selection and peri-procedural management may allow for safe device implantation in cases with significant LAP elevation.
  • Further research is warranted to define optimal management strategies and identify predictors of success in this patient population.

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