JACC: CARDIOVASCULAR INTERVENTIONS
VOL. 8, NO. 4, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcin.2015.02.007
EDITORIAL COMMENT
Percutaneous Closure of Atrial Septal Defects Contraindications Are Hard to Find These Days* Bernhard Meier, MD
W
ith respect to closure of atrial septal
unrelated to the ASD or its closure. Exercise capacity,
defects (ASDs), there is a saying that
heart failure markers, and echocardiographic param-
large ASDs need to be closed because
eters were significantly improved in all age groups
they are large and small ASDs need to be closed
examined. The average hospital stay was more than
because they are small. The saying was the fruit
3 days, but this was likely more due to Japanese cus-
of percutaneous device closure. When open heart
toms than to the age of the patients or the treatment
surgery was the only option, the indication bar was
applied.
set relatively high at a shunt index expressed as
The problem of atrial fibrillation (AF) remains.
Q p /Q s >1.5. This meant that the pulmonary blood
Somewhat surprisingly, the prevalence of permanent
flow volume per minute had to be >50% higher than
AF was only 17%, i.e., 3% in the youngest, 14% in the
the systemic. Smaller shunts were by no means
middle, and 42% in the oldest age group. The ex-
acquitted from enlarging the right ventricle and
pected and also documented decrease in atrial size
both atria or from allowing paradoxical embolism,
may theoretically prevent a new occurrence of AF or
but their respective risks were deemed not to justify
potentially revert some permanent AF. Conversely, it
the perils of open heart surgery. Now, this indication
is known that device closure may trigger AF. There is
threshold has become an oxymoron. There is the
no mention in this paper of a new onset of AF in the
possibility to close a small ASD in an outpatient
roughly 3 years of follow-up. However, that does not
procedure with just local anesthesia of the groin
mean that it did not occur. It may simply not have
in
VOL. 8, NO. 4, 2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-8798/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcin.2015.02.007
EDITORIAL COMMENT
Percutaneous Closure of Atrial Septal Defects Contraindications Are Hard to Find These Days* Bernhard Meier, MD
W
ith respect to closure of atrial septal
unrelated to the ASD or its closure. Exercise capacity,
defects (ASDs), there is a saying that
heart failure markers, and echocardiographic param-
large ASDs need to be closed because
eters were significantly improved in all age groups
they are large and small ASDs need to be closed
examined. The average hospital stay was more than
because they are small. The saying was the fruit
3 days, but this was likely more due to Japanese cus-
of percutaneous device closure. When open heart
toms than to the age of the patients or the treatment
surgery was the only option, the indication bar was
applied.
set relatively high at a shunt index expressed as
The problem of atrial fibrillation (AF) remains.
Q p /Q s >1.5. This meant that the pulmonary blood
Somewhat surprisingly, the prevalence of permanent
flow volume per minute had to be >50% higher than
AF was only 17%, i.e., 3% in the youngest, 14% in the
the systemic. Smaller shunts were by no means
middle, and 42% in the oldest age group. The ex-
acquitted from enlarging the right ventricle and
pected and also documented decrease in atrial size
both atria or from allowing paradoxical embolism,
may theoretically prevent a new occurrence of AF or
but their respective risks were deemed not to justify
potentially revert some permanent AF. Conversely, it
the perils of open heart surgery. Now, this indication
is known that device closure may trigger AF. There is
threshold has become an oxymoron. There is the
no mention in this paper of a new onset of AF in the
possibility to close a small ASD in an outpatient
roughly 3 years of follow-up. However, that does not
procedure with just local anesthesia of the groin
mean that it did not occur. It may simply not have
in
