Challenges in Device Closure of Secundum Atrial Septal Defect in Older Patients in Their Fifth Decade and Beyond

Anil K Singhi; Soumya K Mahapatra; Dilip Kumar; Somnath Dey; Amiya Mishra; Arnab De

doi:10.7759/cureus.22480

Challenges in Device Closure of Secundum Atrial Septal Defect in Older Patients in Their Fifth Decade and Beyond

Cureus. 2022 Feb 22;14(2):e22480. doi: 10.7759/cureus.22480. eCollection 2022 Feb.

Authors

Anil K Singhi¹, Soumya K Mahapatra¹, Dilip Kumar², Somnath Dey³, Amiya Mishra⁴, Arnab De²

Affiliations

¹ Pediatric Cardiology, Medica Super Specialty Hospital, Kolkata, IND.
² Cardiology, Medica Super Specialty Hospital, Kolkata, IND.
³ Cardiac Anesthesia and Critical Care, Medica Super Specialty Hospital, Kolkata, IND.
⁴ Anesthesia, Medica Super Specialty Hospital, Kolkata, IND.

Abstract

Objective Transcatheter atrial septal defect (ASD) device closure in the older population presents a greater challenge due to the long-standing effect of atrial left-to-right shunt. This study analyzes the challenges encountered in transcatheter ASD device closure in older patients in their fifth decade and beyond. Methods Adults aged 40 years and above with significant secundum ASD who underwent transcatheter ASD device closure between June 2015 and April 2021 were analyzed. Challenges were classified as major and minor challenges based on their impact on the alteration of the treatment protocol. Patients were categorized into three subgroups according to age. Group 1 consisted of patients aged 40-49 years (n = 13), Group 2 consisted of patients aged 50-59 years (n = 16), and Group 3 consisted of patients aged 60 years and above (n = 8). Results A total of 37 patients were analyzed. The challenges encountered were arrhythmia, pulmonary hypertension, left ventricular diastolic dysfunction, bleeding, stroke, coronary artery disease (CAD), hypertension, and airway disease. Thirteen percent of challenges were seen in pre-procedure time, whereas 79% of challenges during the procedure and 8% of challenges during post-procedure were seen. Thirty-five patients (94.6%) underwent transcatheter ASD device closure. Two patients (5.4%) did not undergo transcatheter ASD device closure due to severe diastolic dysfunction and associated CAD, respectively. Eleven major challenges were encountered in 10 patients in which one patient had a dual challenge of bleeding and arrhythmia. Thirteen patients (35.1%) had smooth procedures without any challenges encountered. Twenty-seven minor challenges were encountered in 20 patients with some patients having an overlap of multiple major and minor challenges. The patients were doing well at the mean follow-up of 28 months. Conclusions Transcatheter ASD device closure in older patients who are 40 years and above is safe and effective. Such high-risk patients are prone to various challenges that can be effectively managed if optimally monitored on the basis of a proper understanding of the altered physiology and anticipation of the deviated course at various stages of the procedure.

Keywords: arrhythmia; atrial septal defect; bleeding; challenge; device closure; diastolic dysfunction; older patients; pulmonary hypertension; stroke.