Any interventional cardiologist worth his/her salt (especially those interested in structural heart disease) has closed atrial septal defects (ASDs). It is unusual, however, to be referred an elderly patient who has had the diagnosis for many years and has not had a hemo-dynamically significant defect closed surgically. Before the advent of transcatheter closure devices, surgical closure was the gold standard and most patients had hemodynamically significant ASD's closed with minimal risk and good outcomes. Arguably, in the Far East surgical closure has not been as popular and perhaps fewer patients agreed to this option, leading to a pool of elderly patients with ASD's. In this issue of CCI, Nakagawa et al. from Okayama, Japan report on trans-catheter closure of ASD's in a relatively large number (30) of patients with a mean age of 76 +- 4 years . To summarize their findings, patients were followed for a mean period of slightly more than 1 1/2 years (the shortest about 8 months) during which New York Heart Association (NYHA) functional class significantly improved in 3/4 of the patients, as did plasma brain natriuretic peptide (BNP) levels, systolic pulmonary artery pressure, amount of tricuspid regurgitation, and cardiac remodeling.
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