This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Martucci, G. Articles by Landzberg, M. Search for Related Content PubMed Articles by Martucci, G. Articles by Landzberg, M. Related Collections Pediatric and congenital heart disease, including cardiovascular surgery Related Article

Editorial

Not Just Big Kids

Closing Atrial Septal Defects in Adults Older Than 60 Years

Giuseppe Martucci, MD and Michael Landzberg, MD

From the McGill Adult Unit for Congenital Heart Disease Excellence Unit (G.M.), McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada; and Boston Adult Congenital Heart Group (M.L.), Children’s Hospital and Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Michael J. Landzberg, MD, Department of Cardiology, Boston Adult Congenital Heart Group, 300 Longwood Ave, Boston, MA 02115. E-mail michael.landzberg@cardio.chboston.org

Key Words: atrium • defects • heart defects • shunts • atrial septal defect

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Atrial septal defects (ASDs), allowing blood to directly communicate between systemic and pulmonary arterial circulations at the atrial level, are among the most common congenital cardiac anomalies seen in the adult population. The degree of shunting across an ASD is directly related to the area of the ASD and inversely related to the compliance of the combined atrial-ventricular chambers on either side of the heart. Under normal physiological conditions, there is net left-to-right shunting across an ASD, as the left ventricle is far less compliant than the right ventricle. This shunt of fully oxygenated blood back to the right atrium results in a volume load to the right-sided heart chambers and to the pulmonary vasculature; if left untreated, large-volume left-to-right shunting can result in atrial arrhythmias, right ventricular diastolic and systolic failure, worsened functional class, decreased exercise capacity, left ventricular diastolic failure, and, uncommonly, development of pulmonary arterial hypertension.¹

The indication to treat an ASD is typically related to its hemodynamic significance and its effects on the right ventricle. National care guidelines denote ASD closure with class IA recommendation in patients with evidence of right ventricular volume overload without other etiology (reflecting large-volume left-to-right shunting).² The beneficial effects of ASD closure include positive right and left heart remodeling, improvement in symptoms, increase in exercise capacity, reduction in tendency to development of atrial arrhythmias, and decrease in both pulmonary infections and pulmonary arterial pressures.^3–6 Furthermore, when comparing a catheter-based approach with ASD closure with a surgical approach, transcatheter closure may offer . . . [Full Text of this Article]

Related Article

Percutaneous Closure of Atrial Septal Defects: Echocardiographic and Functional Results in Patients Older Than 60 Years

Smita Jategaonkar, Werner Scholtz, Henning Schmidt, and Dieter Horstkotte
Circ Cardiovasc Interv 2009 2: 85-89. [Abstract] [Full Text] [PDF]