Percutaneous atrial septal defect closure in patients with left ventricle failure or pulmonary hypertension

Abstract

Transcatheter approach for closure of an ostium secundum atrial septal defect (ASD) is a safe and effective treatment that is now the first-line therapy in many centers based on various series demonstrating lower complication rates, shorter hospitalizations, and lower costs compared to surgery. Following transcatheter ASD closure, exercise capacity improves within days to weeks, and right heart hemodynamics can improve dramatically. Regression of right heart enlargement typically occurs over weeks to months, and immediate improvements in pulmonary artery pressure (PAP) can be seen with further improvement in late follow-up. Over recent years, the number of elderly patients treated percutaneously for ASD closure has increased. Since this population often presents with diastolic dysfunction, these patients are more prone to acute pulmonary edema following the procedure. Strategies have been developed to identify patients at high risk for post procedural heart failure. Patients with ASD and left to right shunts are also at risk of developing pulmonary hypertension (PHT) and the probability of PHT also increases with age. In this review, we will discuss ASD closure in patients with left ventricle (LV) failure and/or PHT corresponding to specific clinical settings more and more common in clinical practice.