Association between pulmonary hypertension and an atrial septal defect

Post, Martijn C.

doi:10.1007/s12471-013-0432-9

Cited by 25 publications

(22 citation statements)

References 13 publications

(20 reference statements)

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“…7 PAH has been reported in around 9-35% of cases with open or closed atrial septum defect, but the pulmonary vascular disease can be prevented if the left to right shunt is corrected before the development of Eisenmenger syndrome or shunt reversal occurs. 8 Left ventricular failure caused by myocardial ischemia is characterized by increased filling pressures, either due to diastolic dysfunction or mitral regurgitation, which in turn triggers pulmonary venous hypertension and postcapillary pulmonary hypertension. This complex mechanism will lead to endothelial dysfunction and pulmonary vascular remodeling, which in time, will resemble the changes that are present in patients with primary pulmonary hypertension.…”

Section: Pulmonary Arterial Hypertensionmentioning

confidence: 99%

The Effect of Epicardial Fat on the Right and Left Ventricular Function in Subjects with Various Etiological Types of Pulmonary Arterial Hypertension

Raț

Opincariu

Blendea

et al. 2018

Journal of Interdisciplinary Medicine

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Background: Little is known on the effect of epicardial fat in pulmonary arterial hypertension (PAH). Therefore, the present study sought to perform a comparative analysis on the influence of epicardial fat thickness (EFT) on the right and left ventricular function, between three different etiological varieties of pulmonary arterial hypertension: caused by congenital heart defects (atrial septum defects with left to right shunt), by systemic sclerosis, and by myocardial ischemia. Materials and Methods: This is a prospective observational study on 50 patients with documented PAH (systolic pulmonary artery pressure -PASP of >35 mmHg). The thickness of the epicardial adipose tissue was evaluated by 2D cardiac ultrasound, on the free wall of the right ventricle, during end-diastole, in the long parasternal axis view. The patients were divided into three study groups: Group 1 -PAH determined by congenital heart defects with left to right shunts (atrial septum defects, n = 25); Group 2 -PAH induced by systemic sclerosis (n = 12); Group 3 -PAH induced by myocardial ischemia (n = 13). Results: The average age was 54.48 ± 10.78 years, 30% (n = 15) of subjects were males, with a mean body mass index of 24.65 ± 4.40 kg/m 2 , EFT was 9.15 ± 2.24 mm, and the PASP was 41.33 ± 5.11 mmHg. Patients in Group 3 were more likely to smoke (p = 0.025) and presented a significantly lower LVEF, compared to the other groups (Group 1: 60% ± 6 vs. Group 2: 60% ± 7 vs. Group 3: 48% ± 7, p <0.0001). The largest EFT was found in Group 3 (11.08 ± 2.39 mm), followed by Group 2 (9.14 ± 2.03 mm), and Group 1 (8.16 ± 1.57 mm) (p = 0.0003). The linear regression analysis found no significant correlations between EFT and other echocardiographic parameters: PASP (r = -0.228, p = 0.118), LVEF (r = -0.265, p = 0.06), TAPSW (r = 0.015, p = 0.912), TEI (r = 0.085, p = 0.552), RVEDD (r = -0.195, p = 0.173), RA area (r = -178, p = 0.214), and LA diameter (r = 0.065, p = 0.650). Conclusions: Epicardial fat thickness was found to be significantly higher in patients with PAH induced by myocardial ischemia, followed by those with systemic sclerosis and congenital heart defects, respectively. EFT did not influence the echocardiographic parameters for left and right ventricular function in patients with pulmonary arterial hypertension of different etiologies.

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Section: Pulmonary Arterial Hypertensionmentioning

confidence: 99%

The Effect of Epicardial Fat on the Right and Left Ventricular Function in Subjects with Various Etiological Types of Pulmonary Arterial Hypertension

Raț

Opincariu

Blendea

et al. 2018

Journal of Interdisciplinary Medicine

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“…ASDs may be detected in asymptomatic patients, though physical findings may be subtle at best making detection prior to associated symptoms difficult in most clinical settings [2] . Though patients with ASDs may remain asymptomatic well into adulthood, undetected ASDs may lead to potentially irreversible complications such as arrhythmias, pulmonary hypertension, stroke or their associated sequelae [3,4] . The true incidence of ASD may be significantly underestimated due to the nature of their relatively silent clinical course.…”

Section: Introductionmentioning

confidence: 99%

Atrial septal defect repair in the age of transcatheter devices

Zimmermann¹,

Hussain²,

Worku³

et al. 2019

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The aim of this review is to discuss the management of atrial septal defects (ASD) in the adult patient paying special attention to the elderly population and the most recent transcatheter advancements. ASDs are characterized by the following categories: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects; though multiple defects may exist concurrently. Intervention for closure of ASDs are indicated with the development of right ventricular volume overload, or in the clinical context of paradoxical embolic stroke. Previously, there was significant disagreement regarding the timing of ASD closure in adult patients, but there is now general consensus that adult patients with clinical evidence of right ventricular overload should undergo closure of ASDs at the time of presentation. The present review describes the typical presentation of patients with symptomatic ASD's, medical management, and whether surgical or percutaneous approach should be pursued. We will also discuss other important considerations for patient selection and potential early and late complications of transcatheter ASD closure such as congestive heart failure, device embolization, and tissue erosion. At the time of this writing, there are currently three FDA-approved devices for percutaneous VSD closure including the Amplatzer TM Septal Occluder (ASO, St. Jude Medical, St. Paul, MN), Gore HELEX TM Septal Occluder (W.L. Gore and Associates, Newark, NJ), and Gore CARDIOFORM TM Septal occluder (GCSO, W.L. Gore and Associates, Newark, NJ) devices. Many premarket approvals were granted for devices that never went to market due to poor investigational study performance. Likewise, the HELEX device has since been discontinued upon bringing the GCSO device to market. We will focus primarily on the ASO device with a brief review of current investigations into the GCSO device, both of which carry an indication for closure small to medium sized ASDs in the ostium secundum position. Additionally, this review covers the safety of transcatheter closure of ASDs with currently available devices, review studies associated with devices available outside the United States, and perioperative considerations for transcatheter Page 2 of 18 Zimmermann et al. Vessel Plus 2019;3:31 I http://dx.intervention. Obstacles to device employment and countermeasures to overcome operational challenges will also be discussed. To this end, variations or similarities of currently approved devices will be emphasized throughout this discussion where possible. Lastly, we will offer insights into device evolution trends with the expectation of new device developments on the horizon. We will briefly discuss up and coming areas of active research, including the emerging fields of novel biomaterials and gene therapy. MORPHOLOGY AND CLINICAL FEATURES OF ASDS Location, Morphology, and suitability for surgery vs. transcatheter interventionIt is important to note that morphological variations of different types of ASDs, which determines whether a particular defect is amenabl...

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“…A mean artery pressure mPAPe"25 mm Hg is considered to be diagnostic for pulmonary hypertension. 6 Modulation in autonomic activity has been considered to be a factor predisposing to cardiac arrhythmias in pulmonary hypertension patients. 6 Surgical closure of ASD has been shown to lower long term cardiac mortality and morbidity.…”

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confidence: 99%

“…6 Modulation in autonomic activity has been considered to be a factor predisposing to cardiac arrhythmias in pulmonary hypertension patients. 6 Surgical closure of ASD has been shown to lower long term cardiac mortality and morbidity. Early surgical intervention may even reduce the long-term risk of developing atrial arrhythmias.…”

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The Effect of Preoperative Pulmonary Arterial Hypertension on Incidence of Postoperative Atrial Fibrillation after Surgical Closure of Atrial Septal Defect (Secundum)

ManzurulAlam

Ahmed

et al. 2018

Univ. Heart J.

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Background: Atrial tachyarrhythmias are common among adults with ASD and contribute to substantial morbidity. Atrial flutter and atrial fibrillation are well-described complications of atrial septal defect (ASD) and are associated with substantial morbidity. The cause of AF in ASD is multifactorial in nature. It has been proposed that it is related to atrial dilatation, the increase in pulmonary pressure, and ventricular dysfunction. Early surgical intervention may reduce the long-term risk of developing atrial arrhythmias. Studies demonstrated that cardiac remodeling occurred after closure of an ASD, even in older patients. This study aimed to find out the pulmonary hypertension (PAH) as a predictor of postoperative atrial fibrillation in patients after surgery for secundum type atrial septal defect closure.Methods: This Prospective Observational Study carried out in department of cardiac surgery, National Institute of Cardiovascular Disease (NICVD) and Hospital, Dhaka, Bangladesh during the period of July, 2015 to June, 2016. Total 54 patients are taken and then grouped into group A and group B. Each group contains 27 patients. Group A include Patients with ASD secundum without PAH. Group B Patients with ASD secundum with PAH. All patients were evaluated with M-mode, 2D and color Doppler transthoracic echocardiography and ECG before operation, at discharge, after one month and at 3 months follow-up. Statistical analysis of the results was obtained by windows based computer software with statistical package for the social sciences program (SPSS version 21).Results: To compare atrial fibrillation postoperative at discharge and postoperative after 1 and 3 months follow-up it was found In group B 8 (29.62%) patients had AF postoperatively, during discharge 8 (29.62%) patients had AF, after 1 month 7 (25.93%) patient had AF, after 3 months 6 (22.22%) patients had AF. No AF was found in Group A patients during postoperatively, during discharge, after 1 month & 3 months follow up. Statistical significant difference was found in between two groups (p<0.05).Conclusion: The surgical correction of atrial septal defect (ASD) is safe and effective procedure. Our studyshowed that the haemodynamic and electrophysiological results of the surgical repair of ASD secundum was superior before the development of pulmonary arterial hypertension. After surgical correction of ASD secundum raised pulmonary artery pressure became lower gradually. Atrial fibrillation developed in patient group with pulmonary arterial hypertension in postoperative period remain persistent in most patients in the follow up period, few converted to sinus rhythmUniversity Heart Journal Vol. 13, No. 1, January 2017; 17-20

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Association between pulmonary hypertension and an atrial septal defect

Cited by 25 publications

References 13 publications

The Effect of Epicardial Fat on the Right and Left Ventricular Function in Subjects with Various Etiological Types of Pulmonary Arterial Hypertension

The Effect of Epicardial Fat on the Right and Left Ventricular Function in Subjects with Various Etiological Types of Pulmonary Arterial Hypertension

Atrial septal defect repair in the age of transcatheter devices

The Effect of Preoperative Pulmonary Arterial Hypertension on Incidence of Postoperative Atrial Fibrillation after Surgical Closure of Atrial Septal Defect (Secundum)

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