Document Detail


Transcatheter closure of atrial septal defects in adults > or =40 years of age: immediate and follow-up results.
MedLine Citation:
PMID:  17300410     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Controversy still exists regarding closure of atrial septal defects (ASDs) in patients >40 years of age who are largely asymptomatic or do not have large shunts (LS). If left unrepaired, the majority of patients will experience symptoms and will have a shorter life span compared to patients who undergo repair. This study presents the outcomes of closure of ASDs in adults >40 years using the Amplatzer septal occluder. METHODS: A total of 113 patients (79F/34M) with a mean age of 57.9 years (SD 11.9) who had indications for closure (right ventricular [RV] enlargement by echocardiograpy, clinically symptomatic) underwent an attempt of transcatheter closure. The mean size of ASD as measured by transesophageal echocardiography (TEE) (30 patients) or intracardiac echocardiography (83 patients) was 17.2 mm (SD 7.3) with mean Qp:Qs of 2.2:1 (SD 1.1). Follow-up at 24 hours, 6 month, and yearly thereafter included physical examination, TEE, and/or transthoracic echocardiography; furthermore, chart review (n = 112) as well as telephone interviews (n = 56) were conducted to determine clinical symptomatic status. RESULTS: The procedure was successful in 112 patients and 1 patient failed due to the presence of a large defect (44 mm). One hundred four patients had a single device implanted, 7 had two, and 1 had three. Following the procedure, 96 patients had immediate complete closure (CC), 3 had trivial shunt (TS), 11 had small shunt (SS), and 2 had moderate shunt (MS). At 24 hours postprocedure, 100 patients had CC, 7 had TS, 3 had SS, 1 had MS, and 1 had LS. Four patients had complications: one had device migration within 24 hours, two had atrial arrhythmias (supraventricular tachycardia, atrial tachycardia), and one had large hematoma. At 6 months postprocedure, 100 patients had CC, 6 had TS, 5 had SS, and 1 had MS. At 6-month follow-up, the right ventricle end-diastolic dimension decreased from 35.3 mm (SD 7.6) preprocedure to 23.8 mm (SD 6.6) (P < 0.001) and the majority of patients reported improvement in their symptoms. CONCLUSIONS: ASD closure is safe and effective in patients over 40 years of age with minimal complications. The procedure resulted in a decrease in the RV size that was accompanied by improvement in clinical symptoms. Our findings suggest that device closure of ASDs in adult patients >40 years of age should be the first option of management.
Authors:
Angira Patel; Keila Lopez; Anirban Banerjee; Annette Joseph; Qi-Ling Cao; Ziyad M Hijazi
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of interventional cardiology     Volume:  20     ISSN:  0896-4327     ISO Abbreviation:  J Interv Cardiol     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-15     Completed Date:  2007-03-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8907826     Medline TA:  J Interv Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  82-8     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, University of Chicago Hospitals, Pritzker School of Medicine, Chicago, Illinois 60637, SUA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Echocardiography, Doppler, Color
Echocardiography, Transesophageal
Female
Follow-Up Studies
Heart Catheterization / instrumentation*
Heart Septal Defects, Atrial / physiopathology,  radiography,  therapy*,  ultrasonography
Humans
Illinois
Male
Middle Aged
Prostheses and Implants*
Prosthesis Design
Questionnaires
Severity of Illness Index
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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