Baseline Characteristics
A total of 18 patients above 60 years old underwent transcatheter ASD
closure during this period and only 6 patients had chronic atrial
fibrillation. The baseline characteristics of the six consecutive
subjects are listed in Table 1. All patients had a right atrial area of
more than 20cm2 and expectedly, all were in chronic
atrial fibrillation. The mean CHADS2 and
CHA2DS2-VASc scores
were 2.33±0.82 and 3.83±0.75 while the mean HAS-BLED score was
1.83±0.75. None of the subjects had a history of major bleeding and none
were contraindicated to oral Warfarin. All these patients were
symptomatic.
In the first subject, LAA was occluded first. Upon finding satisfactory
occlusion of the LAA on transesophageal echocardiogram after 7 weeks,
the ASD was closed. The initial concern was the possibility of
incomplete closure of the LAA. Closure of the ASD with the metallic
device would complicate further intervention to the LAA if the LAA
closure was left with a significant residual flow or the device has
embolized 9,10. In the subsequent 4 subjects, the ASDs
were closed simultaneously with the LAA. The LAA occluder was observed
for five minutes for possible embolization prior to the ASD closure. In
the last subject, ASD was performed in a live transmission to an
interventional meeting; the LAA had to be performed 1 week before the
live transmission. The patient was informed of the staged procedure to
which she agreed. In that patient, fenestration was not created at the
device, instead, a pre-manufactured fenestrated atrial septal occluder
was used.