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-VAS 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.