Percutaneous device closure of secundum atrial septal defect in older adults.

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.