Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
BMC Cardiovasc Disord. 2023 Jan 12;23(1):15. doi: 10.1186/s12872-023-03046-9.
Atrial septal defect (ASD) can often remain asymptomatic until adulthood. It still remains unclear whether large ASD closure in senior people should be performed or not. Temporary ASD balloon occlusion test has been suggested as a tool to assess the risk of acute left ventricular heart failure post-ASD closure, and it allows to better distinguish responders from non-responders.
An 83-year-old man with a long-standing uncorrected secundum ASD was admitted for recently decompensated right-sided heart failure. During hospitalization, this patient was studied with trans-esophageal echocardiography, cardiac magnetic resonance imaging, and right heart catheterization, showing high Qp:Qs ratio and favorable anatomical conditions for percutaneous closure. Because of patient's increasing need for intravenous diuretics and worsening renal function, it was considered that transcatheter ASD closure could improve symptoms, hence it was performed an attempt of percutaneous closure of the ASD with a fenestrated device. Unfortunately, irrespective of ASD being hemodynamically significant, it was found a very significant increase in pulmonary capillary wedge pressure during the temporary balloon occlusion test, supporting the existence of concealed left ventricular diastolic dysfunction. As a result, it was decided to abandon the procedure and not to close the ASD.
This clinical case illustrates the value of temporary balloon occlusion test before permanent percutaneous closure of ASD in elderly patients, regardless of left ventricular (systolic or diastolic) dysfunction.
房间隔缺损（ASD）在成年之前通常无症状。目前仍不清楚老年人是否应进行大 ASD 封堵。临时 ASD 球囊阻断试验已被建议作为评估 ASD 封堵后急性左心衰竭风险的工具，它可以更好地区分有反应者和无反应者。
一名 83 岁男性患有长期未矫正的继发孔 ASD，因近期失代偿性右侧心力衰竭入院。住院期间，该患者接受了经食管超声心动图、心脏磁共振成像和右心导管检查，结果显示 Qp:Qs 比值高，且经皮封堵的解剖条件良好。由于患者对静脉利尿剂的需求增加和肾功能恶化，考虑到经导管 ASD 封堵可能改善症状，因此尝试使用带孔设备进行经皮 ASD 封堵。然而，尽管 ASD 具有血液动力学意义，但在临时球囊阻断试验中发现肺毛细血管楔压显著升高，支持存在隐匿性左心室舒张功能障碍。因此，决定放弃该程序，不关闭 ASD。
无论左心室（收缩或舒张）功能障碍如何，该临床病例都说明了在老年患者永久性经皮 ASD 封堵前进行临时球囊阻断试验的价值。
