Dehghani Hossein, Boyle Andrew J
Department of Medicine, Division of Cardiology, University of California San Francisco San Francisco, CA, USA.
Am J Cardiovasc Dis. 2012;2(2):133-42. Epub 2012 May 15.
Ostium secundum atrial septal defect (ASD) is a common congenital heart defect. The adverse prognosis of untreated ASD diagnosed in childhood is well studied and percutaneous device closure of these ASDs has evolved to become the standard of care in both pediatric and young adult populations. There is a growing body of literature that suggests the benefits of ASD closure are not restricted to younger populations. In older adults, there are beneficial effects on cardiac chamber geometry, pulmonary artery pressures, patient symptoms and exercise capacity with closure of the ASD, and these salutary effects appear to be more pronounced the earlier the defect is closed. There may even be a reduction in the development of atrial arrhythmias, although this remains to be conclusively demonstrated. In this review, we summarize the literature regarding ASD closure in older adults. The weight of evidence suggests that ASD should be closed percutaneously earlier rather than later, and consideration should be given to percutaneous device closure of ASD in adults upon diagnosis, rather than waiting for symptoms or cardiac chamber dilatation.
继发孔型房间隔缺损（ASD）是一种常见的先天性心脏缺陷。儿童期诊断出的未经治疗的ASD的不良预后已得到充分研究，这些ASD的经皮器械封堵已发展成为儿科和年轻成人人群的标准治疗方法。越来越多的文献表明，ASD封堵的益处并不局限于年轻人群。在老年人中，ASD封堵对心腔几何形状、肺动脉压力、患者症状和运动能力有有益影响，而且这些有益影响似乎在缺损闭合越早时越明显。甚至可能会减少房性心律失常的发生，尽管这一点仍有待最终证实。在本综述中，我们总结了关于老年人ASD封堵的文献。证据表明，ASD应尽早而非推迟进行经皮封堵，对于成人ASD诊断后应考虑经皮器械封堵，而不是等待出现症状或心腔扩张。
