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ASD Closure in Elderly with HFpEF — EECC MCQ

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HardCongenital Heart Disease (Adult)ASD Closure in Elderly with HFpEFEECC

A 68-year-old woman with HFpEF (LVEF 55%) and a large secundum ASD (Qp:Qs 2.5:1) with RV dilatation is assessed. She has exertional dyspnoea (NYHA III) and moderate TR. Can the ASD be closed?

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Correct answer: E — ASD closure should be considered as the significant left-to-right shunt (Qp:Qs >1.5) is causing RV volume overload and symptoms, provided PVR is not severely elevated and there is no net right-to-left shunting

Secundum ASD with significant left-to-right shunting (Qp:Qs ≥1.5:1) causing RV volume overload and symptoms is an indication for closure regardless of age, provided: (1) PVR is not irreversibly elevated (PVR <5 WU, or PVR:SVR <0.33); (2) there is no net right-to-left shunting (Eisenmenger); (3) anatomy is suitable for device closure. The 2020 ESC ACHD Guidelines recommend percutaneous device closure for secundum ASDs with suitable anatomy (sufficient rims, adequate size). In older patients with HFpEF, balloon occlusion testing with haemodynamic assessment may be performed to predict LV response to closure (as increased LV preload may unmask LV diastolic dysfunction). Concomitant TR often improves after ASD closure due to RV reverse remodelling.

Reference: ESC (2020): Guidelines for Adult Congenital Heart Disease