Clinical Analysis Of 25 Elderly Patients With Secundum Atrial Septal Defects Receiving Percutaneous Catheter Closure

Objective:To investigate the clinical characteristics of the elderly patients with secundum atrial septal defect（ASD）and the safety and efficacy of percutaneous catheter closure.Methods:A total of 25 elderly patients with secundum ASD who received percutaneous catheter closure in the first affiliated hospital of guangxi medical university from March 2007 to December 2017 were retrospectively analyzed.All of them were aged 60 or over.Clinical and followed up data were analyzed.Clinical data included Clinical manifestations,electrocardiogram（ECG）,trans-thoracic echocardiography（TTE）parameters and right heart catheterization para-meters.Results:（1）A total of 25 elderly patients with secundum ASD,8 males and17 females,aged from 60 to 69 years.（2）72%（18/25）of patients with multiple symptoms,including exertional dyspnea（44%）,palpitations（48%）and chest distress（40%）.（3）88%（22/25）of patients could be heard an a loud and fixed split of P₂ and varying degrees of systolic murmur in the pulmonary artery auscultation area.（4）84%（22/25）of patients had at least one major comorbidity,4cases of atrial fibrillation,8 cases of hypertension,2 cases of coronary atheroscl-erotic heart disease,3 cases of coronary artery atherosclerosis,8 case of hyperli-pidemia,1 case of diabetes mellitus,4 cases of hyperuricemia and 1 case of chronic obstructive pulmonary disease,respectively.（5）64%（16/25）of patients with New York Heart Association（NYHA）functional class I,28%（7/25）cases of NYHA class II and 8%（2/25）cases of NYHA class III.（6）84%（21/25）of patients with abnormal ECG,including incomplete right bundle branch block（IRBBB）in 9 cases,complete right bundle branch block（CRBBB）in 1 case,atrial fibrillation in 4 cases,first-degree atrioventricular block in 2 cases,right ventricular hypertrophy in 2 cases and right axis deviation in 2 cases.（7）88%（22/25）of patients’Chest radiography showed heart with a different degrees of enlargement,cardiothoracic ratio range 0.51 to 0.77（0.59±0.065）.（8）Different degrees of dilatation of right atrial dimension（RAD）（51.13±7.14）mm and right ventricular dimension（RVD）（34.56±8.12）mm were observed in the results of TTE and all cases were accompanied with different degrees of tricuspid regurgitation（TR）（range 3 to 37ml）.The RAD of patients with TR≥10 ml was significantly greater in patients with TR<10 ml（P<0.001）and 52%（13/25）of patients with mild mitral regurgitation（MR）.（9）The results of right heart catheterization showed mean pulmonary arterial pressure（mPAP）was（25.00±7.84）mmHg（range 14 to 41mmHg）and 56%（14/25）cases of pulmonary artery hypertension（PAH）.The pulmonary blood flow/systemic blood flow ratio was（2.18±0.95）（range 1.1 to 4.3）and the pulmonary vascular resistance（PVR）was（2.24±1.04）WU（range 1 to 4.4 WU）.（10）The success rate of percutaneous catheter closure was 100%,with almost no complications.（11）The average of follow-up times was（44.4±37.1）months（range 4 to 133 months）,5 patients were lost to follow-up,and the follow-up rate was 80%.2 patients were died,1case of cerebral infarction and 1 patient with atrial fibrillation was admitted to hospital again due to palpitations and one patient with varicose veins of both lower extremities was due to bilateral lower extremity edema.The symptoms of exertional dyspnea and chest distress were significantly improved as well as the daily activity tolerance and none of patients admitted to the hospital again due to heart failure after ASD closure.（12）The follow-up results of TTE,showed the pre-operation parameters of RAD,RVD and TR decreased significantly compared with post-operation at 1 day,1,3,6,12 months（all P<0.05）.Left ventricular end-diastolic dimension（LVEDD）significantly increased at1day,1,3,6,12 months after procedure（all P<0.0 5）.Left ventricular ejection fraction（LVEF）and left ventricular end-systolic dimension（LVESD）did not significantly change at post-procedure of 1 day,1,3,6,12 months（all P>0.05）.At 1 day after percutaneous closure,significant decreases in the LAD（P<0.05）,whereas there was no significant difference at 1,3,6,12 months post-closure（P>0.05）.Conclusion:（1）The elderly patients with secundum ASD were often accom-panied by a variety of senile diseases,with labor-induced shortness of breath,palpitations,chest tightness as the main symptoms and a variety of symptoms coexist,but most of them with the normal cardiac function.（2）The issues of accompanying tricuspid regurgitation and atrial fibrillation were worthy of concentration in clinical practice in elderly patients with secundum ASD,not unexpectedly,compared with patients less than 60 years old,they shared the same characteristics,such as a loud and fixed split of P₂,different degrees of pulmonary systolic murmur,right bundle branch block of ECG performance and right-sided volume overload.（3）Nearly half of elderly patients with secundum ASD with non-PAH.In spite of them were associated with PAH,mild of PAH was majority.（4）Percutaneous catheter closure of secundum ASD can be performed safely and with the high success rate even in elderly patients and they profit in terms of symptoms reduction,improvement of exercise capacity as well as cardiac remodeling.