Surgical treatment for secundum atrial septal defects in adults &gt;40 years old: a randomized clinical trial

Attié, Fause; Rosas, Martı́n; Granados, Nuria; Zabal, Carlos; Buendía, Amparo Benedicto; Calderon, Johanna

doi:10.1016/s1062-1458(02)00642-6

Cited by 60 publications

(94 citation statements)

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“…The upper age limit at which these benefits have been shown was extended by Attie et al who randomised over 500 patients aged over 40 (mean age 51 but including over 100 patients aged ">60") to medical treatment or surgical closure [3]. Percutaneous closure in children and young adults offers advantages over surgical closure in that procedural morbidity is reduced.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment options include medical management, percutaneous closure and open surgical closure. There is clear evidence that children and young adults with an ASD and consequent symptoms, or who are asymptomatic but are shown to have a haemodynamically significant shunt, do better symptomatically, haemodynamically and in terms of survival if the ASD is closed [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

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Short and medium-term effects of secundum atrial septal defect percutaneous closure using the Amplatzer Septal Occluder in the elderly

Broadley¹,

Gogola²,

Roobottom³

et al. 2017

Blood Heart Circ

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Aim: to assess the effects of percutaneous secundum atrial septal defect (ASD) closure in the elderly. Methods and results:Descriptive, retrospective study in a large Regional University Teaching Hospital. Subjects were 11 patients aged over 60 (mean age 72 [range 62 to 83], 3 male) at the time they underwent percutaneous closure of a secundum ASD using an Amplatzer septal occluder (ASO). Post-closure the following parameters were significantly reduced: heart size on serial chest X-ray, from a mean (standard deviation) of 16.7 (2.1) cm to 14.8 (1.3) cm (p=0.016) after 4.5 (2.1) months; pulmonary vascularity on serial chest X-ray; right ventricular diastolic diameter on serial transthoracic echocardiogram, from 4.2 (0.8) cm to 3.0 (0.74) cm (p<0.001) after a mean of 15 (12.2) months; and right ventricular systolic pressure measured indirectly (n=4). Symptoms, particularly shortness of breath, also seemed to improve although they were not quantitatively assessed.Conclusion: percutaneous closure of ASD in the elderly using an ASO results in significant reduction in right ventricle and pulmonary artery size, improved haemodynamics and probably also symptoms. On this basis it should be considered in all cases where it is technically feasible, in preference to continuing medical therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short and medium-term effects of secundum atrial septal defect percutaneous closure using the Amplatzer Septal Occluder in the elderly

Broadley¹,

Gogola²,

Roobottom³

et al. 2017

Blood Heart Circ

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“…207,208 Atrial fibrillation, rather than atrial flutter, predominates in the majority; incidence increases with patient age. Surgical or percutaneous closure of ASDs associated with pulmonary blood flow/systemic blood flow (Qp/Qs) more than 1.5 and or symptoms before the age of 40 years may reduce atrial arrhythmias but has little effect after the age of 40 years.…”

Section: A Atrial Septal Defectmentioning

confidence: 99%

“…Surgical or percutaneous closure of ASDs associated with pulmonary blood flow/systemic blood flow (Qp/Qs) more than 1.5 and or symptoms before the age of 40 years may reduce atrial arrhythmias but has little effect after the age of 40 years. [207][208][209] Gatzoulis and coworkers retrospectively reviewed 218 adults who had surgical closure of an isolated ASD. 207 Sustained atrial flutter or AF was present in 19% of patients prior to surgery, 5% had atrial flutter, 2.8% had AF and atrial flutter, and 11% had AF.…”

Section: A Atrial Septal Defectmentioning

confidence: 99%

“…208 Prior to randomization, 21% of patients had a history of AF or atrial flutter managed with rate control and anticoagulation, and 5% had a history of other types of SVT. During a median follow-up of 7.3 years, new atrial flutter or AF developed in 7.4% of patients in the surgical group and 8.7% of patients in the medical group.…”

Section: A Atrial Septal Defectmentioning

confidence: 99%

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ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary

Blomström‐Lundqvist¹,

Scheinman²,

Aliot³

et al. 2003

Circulation

658

204

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Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings

Miranda

Hagler

Reeder

et al. 2019

Cathet Cardio Intervent

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Objective: To review our experience with balloon testing prior to atrial septal defect (ASD) closure in adults with left ventricular (LV) diastolic dysfunction.Background: ASD closure in patients with LV diastolic dysfunction may precipitate LV failure.Temporary ASD occlusion has been used in this scenario but data are limited.Methods: Retrospective review of 27 patients age ≥ 50 years undergoing temporary ASD balloon occlusion between 2000 and 2018 for suspected LV diastolic dysfunction or elevated LV end-diastolic pressure (LVEDP).Results: Median age was 72 years (IQR 66.7; 75.2). Atrial fibrillation was seen in 58% of patients, hypertension in 58%, and coronary artery disease in 26%; 52% were females. Median ASD size was 13 mm (10; 18) and Qp/Qs 1.8 (1.6; 2.2). Median LVEDP was 14 mmHg (12; 22); pulmonary artery wedge pressure (PAWP) 12 mmHg (9; 16.5) and left atrial pressure (LAP) 13.5 mmHg (8; 16.3). After a median of 5 min (3; 10) of balloon occlusion, patients with baseline LVEDP ≥15 mmHg had more significant increases in LVEDP (9 [6; 12] vs. 2 mmHg [0.5; 5]; p = 0.03) and LAP/PAWP (10.5 [8.3; 16.3] vs. 1.5 mmHg [−1.5; 3]; p = 0.0003) than those with baseline LVEDP <15 mmHg. None of those with a baseline LVEDP <15 mmHg had a LAP/PAWP >15 mmHg during balloon testing compared to 92% of patients with a baseline LVEDP ≥15 mmHg. Conclusion: LVEDP might be used to predict LAP post-ASD closure. Comorbidities typically associated with LV diastolic dysfunction are common in these patients and should be considered in their management. K E Y W O R D S adult congenital heart disease, atrial septal defect, hemodynamics, left ventricular diastolic dysfunction

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Surgical treatment for secundum atrial septal defects in adults >40 years old: a randomized clinical trial

Cited by 60 publications

References 0 publications

Short and medium-term effects of secundum atrial septal defect percutaneous closure using the Amplatzer Septal Occluder in the elderly

Short and medium-term effects of secundum atrial septal defect percutaneous closure using the Amplatzer Septal Occluder in the elderly

ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary

Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings

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