Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 39(4): 171-178 (2023)


高齢者での単純短絡心疾患Simple Shunt Disease in the Elderly Patient with Adult Congenital Heart Disease

1東京大学医学部附属病院 循環器内科Department of Cardiovascular Medicine, The University of Tokyo Hospital ◇ Tokyo, Japan

2東京大学保健健康推進本部Division for Health Service Promotion, The University of Tokyo ◇ Tokyo, Japan

発行日:2023年12月31日Published: December 31, 2023


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.

Key words: adult congenital heart disease; atrial septal defect; heart failure; atrial fibrillation; left ventricular diastolic dysfunction

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