Masked left ventricular restriction in elderly patients with atrial septaldefects: A contraindication for closure?

The impact of an atrial septal defect in the elderly with reduced diastolic elasticity of the left ventricle is unclear. We studied the hemodynamic ch anges during balloon occlusion of atrial septal defects in patients over 60 years of age. In 18 patients (61-78 years old; median, 70), the left atria l pressure and the mitral valve inflow was measured during complete balloon occlusion of the defect and after deflation of the balloon. In seven patie nts, the left atrial pressure and the E/A ratio of the mitral valve inflow increased markedly (P = 0.02). Mean atrial pressures reached values of 27 m m Hg and the v-wave peak values of 55 mm Hg. Two patients received a transc atheter device closure and developed congestive heart failure. In the elder ly, an atrial septal defect can have a decompressive impact on the left ven tricle. Therefore, caution appears to be warranted if atrial septal closure is planned. Cathet Cardiovasc Intervent 2001;52:177-180. (C) 2001 Wiley-Li ss, Inc.