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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
Summary
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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