Features of endovascular closure of secondary atrial septal defect in older patients

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Abstract

Aim. Secondary atrial septal defect (ASD II) is one of the most common congenital heart defects. While all the issues of endovascular correction of this disease in children and young patients have been practically resolved, many issues still remain debatable regarding the treatment of adult patients. In the proposed work, the author analyzes the main information’s discussed in the literature concerning this issue, such as the expediency and tactics of treatment of adult patients with ASD II, depending on its anatomical forms, the status of intracardiac and pulmonary-arterial hemodynamics, the presence of concomitant diseases. Materials and methods. The article presents a literature review based on the results of searching of publications in Russian and international bibliographic databases (PubMed, eLIBRARY, Medscape, etc.). Results. Analysis of the literature data in most cases indicates the feasibility and high efficiency of endovascular closure of hemodynamically significant ASD II in elderly patients. The analysis of dynamic observations in the long term after endovascular treatment, reveals a decrease in MPAP as well as the size of the right heart. At the same time, compliance with certain rules makes the intervention quite safe, regardless of the age of patients and, to a certain extent, the severity of symptoms. In the literature, it is particularly emphasized that when determining the management tactics of adult patients with ASD II in order to prevent possible complications, should be objectively evaluated and taken into account such factors that determine their initial state as: the presence of high MPAP, volume overload of the right heart, and vice versa, underloading of the left heart, the conditions of the heart valves, the presence of arterial hypertension, existence of heart rhythm disorders, ischemic heart disease and left ventricle dysfunction. Conclusion. Modern medical literature convincingly proves that with the right selection of patients, transcatheter closure is a safe, highly effective method of correction of ASD II, accompanied by real economic effect and it should be considered a standard in the treatment of middle-aged and elderly patients. At the same time, studies on long-term results show that the positive functional effect does not have age restrictions.

About the authors

Ilya A. Kovalchuk

Sechenov First Moscow State Medical University (Sechenov University)

Email: kovalchuk_ilya@mail.ru
канд. мед. наук, врач по рентгенэндоваскулярным диагностике и лечению, ассистент каф. интервенционной кардиоангиологии Moscow, Russia

Ionatan R. Rafaeli

Sechenov First Moscow State Medical University (Sechenov University)

д-р мед. наук, сердечно-сосудистый хирург Moscow, Russia

Aleksey V. Azarov

Sechenov First Moscow State Medical University (Sechenov University)

канд. мед. наук, зав. отд-нием, врач по рентгенэндоваскулярным диагностике и лечению, доц. каф. интервенционной кардиоангиологии Moscow, Russia

Sergey P. Semitko

Sechenov First Moscow State Medical University (Sechenov University)

д-р мед. наук, проф. каф. интервенционной кардиоангиологии ИПО, дир. Научно-практического центра интервенционной кардиоангиологии Moscow, Russia

David G. Ioseliani

Sechenov First Moscow State Medical University (Sechenov University)

акад. РАН, д-р мед. наук, проф., зав. каф. интервенционной кардиоангиологии Moscow, Russia

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