What evidence is there that patients with high-risk anatomic features are more likely to benefit from device closure?
There is evidence that patients with high-risk anatomic features, including larger shunt size (defined variably), particularly an atrial septal aneurysm, are more likely to benefit from device closure.563 The individual patient level meta-analysis of the first 3 trials552 found slightly greater benefit among patients with these characteristics, but the differences did not approach statistical significance. In contrast, the RESPECT showed significant interactions between treatment and both larger shunt size (>20 micro- bubbles) and atrial septal aneurysm, with benefit shown only when either was present.