Benefit of atrial septal defect closure in adults: impact of age

Abstract

Aims: To evaluate the effect of age on the clinical benefit of atrial septal defect (ASD) closure in adults.

Methods and results: Functional status, the presence of arrhythmias, right ventricular (RV) remodelling, and pulmonary artery pressure (PAP) were studied in 236 consecutive patients undergoing transcatheter ASD closure [164 females, mean age of 49 ± 18 years, 78 younger than 40 years (Group A), 84 between 40 and 60 years (Group B) and 74 older than 60 years (Group C)]. Defect size [median 22 mm (inter-quartile range, 19, 26 mm)] and shunt ratio [Qp:Qs 2.2 (1.7, 2.9)] did not differ among age groups. Older patients had, however, more advanced symptoms and both, PAP (r = 0.65, P < 0.0001) and RV size (r = 0.28, P < 0.0001), were significantly related to age. Post-interventionally, RV size decreased from 41 ± 7, 43 ± 7, and 45 ± 6 mm to 32 ± 5, 34 ± 5, and 37 ± 5 mm for Groups A, B, and C, respectively (P < 0.0001), and PAP decreased from 31 ± 7, 37 ± 10, and 53 ± 17 mmHg to 26 ± 5, 30 ± 6, and 43 ± 14 mmHg (P < 0.0001), respectively. Absolute changes in RV size (P = 0.80) and PAP (P = 0.24) did not significantly differ among groups. Symptoms were present in 13, 49, and 83% of the patients before and in 3, 11, and 34% after intervention in Groups A, B, and C. Functional status was related to PAP.

Conclusions: At any age, ASD closure is followed by symptomatic improvement and regression of PAP and RV size. However, the best outcome is achieved in patients with less functional impairment and less elevated PAP. Considering the continuous increase in symptoms, RV remodelling, and PAP with age, ASD closure must be recommended irrespective of symptoms early after diagnosis even in adults of advanced age.

Figure 1

Correlation between systolic pulmonary artery pressure and age (r = 0.65, P < 0.0001).

Figure 2

Right ventricular (RV) size before, 1 day, 1 week, and 3 months after atrial septal defect closure for patients younger than 40 years (green line), patients aged 40–60 years (orange line), and patients older than 60 years (red line).

Figure 3

Systolic pulmonary artery pressure (sPAP) before, 1 day, 1 week, and 3 months after atrial septal defect closure for patients younger than 40 years (green line), patients aged 40–60 years (orange line), and patients older than 60 years (red line).

Figure 4

Symptomatic status before (pre) and after (post) atrial septal defect closure for patients younger than 40 years, patients aged 40–60 years, and patients older than 60 years.