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Objective: Closure of atrial septal defect in patients with borderline shunt is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in the patients with the borderline shunt.Methods: 140 pts (105 F, 35 M) with a mean age of 33.2 ± 17.7 (20-49) years with a small ASD who underwent transcatheter closure were analyzed. All patients had an isolated secundum ASD with pulmonary to systemic blood flow - Qp:Qs ratio≤ 1.5, mean 1.3 ±0.5 (1.1-1.5). A symptom-limited treadmill exercise test with respiratory gas exchange analysis, transthoracic color Doppler echocardiographic study and Quality of life (QoL) (using the SF36 questionnaire (SF36q)) were repeated in all pts before and 12 months after the procedure.Results: An ASO device was successfully implanted in all pts (procedure time 20.1±4.4 (8-34) minutes, fluoroscopy time 8.4 ± 4.7(6-12) minutes). There were no major complications. The defect echo diameter was 7.2 ± 3.9 (6 - 15) mm. The diameter of the implanted devices ranged from 8 to 18 mm. After 12 months of ASD closure, all the pts showed a significant improvement of exercise capacity. 7 QoL parameters (except mental health) improved at 12 months of follow-up compared with baseline. The mean SF36q scale increased in 121 (86.4%) pts of mean 49.2±26.1 (9-69). The right ventricular dimension decreased in 120 pts (85.7%) (Table 1).Conclusions: ASD closure in patients with borderline shunt resulted in a significant and long-term clinical and hemodynamic improvement after percutaneous treatment.