A Temporary Balloon Occlusion Test: An Essential Step Prior to ASD Closure in The Elderly

ASD Closure in Elderly

Abstract

The current treatment of secundum atrial septal defect (ASD) in both children and adult is transcatheter closure of the defect in the setting of appropriate anatomy. Both pulmonary hypertension and left ventricular systolic or diastolic dysfunction are a prohibitive conditions for closure of ASD.  Elderly patients with ASD may have left ventricular dysfunction given the frequent comorbidities in this patient population. Patients with decreased left ventricular compliance, ASD closure may trigger acute pulmonary oedema by an abrupt increase in left atrial pressure. In this population, balloon occlusion testing is recommended before closure of defect.  In the current era, there is no certain cut-off value for left ventricular end-diastolic pressure (LVEDP) or left-atrial pressure (LAP) whenever device implantation is contraindicated.  Here, we presented 64-year-old male patient with a large secundum ASD with left ventricular diastolic dysfunction. We decided to close the defect on the absence of left ventricular end-diastolic pressure (LVEDP) increase after balloon occlusion test.