Simple Shunt Disease in the Elderly Patient with Adult Congenital Heart Disease

Abstract

Simple shunt diseases are common in older adults with congenital heart disease. The most frequent disease is atrial septal defect (ASD). The pathophysiology of ASD in elderly individuals is notably intricate, marked by an elevated incidence of complications such as heart failure, valvular disease, and atrial fibrillation, stemming from enduring right ventricular volume overload. With the widespread use of percutaneous catheter closure of ASD, even elderly ASD patients are now undergoing closure. In the case of ASD closure in patients with heart failure or atrial fibrillation, it is imperative to administer comprehensive treatment for these comorbidities prior to embarking on the closure procedure. Elderly patients with ASD commonly present not only with manifestations of right-sided heart failure but also exhibit compromised left ventricular diastolic function, necessitating vigilant management of congestion during and post-closure. Ventricular septal defect (VSD) is the second most frequent form of ACHD in the elderly. Patients with VSD that persist into adulthood have small defects or pulmonary hypertension, but the effects of aging should be noted because of the increased risk of decreased left ventricular compliance and heart failure. Additionally, Patent Ductus Arteriosus (PDA) represents another relatively prevalent condition, and with the advent of percutaneous catheter-based closure, more elderly patients are becoming eligible for this therapeutic intervention.