Atrial septal defects and pulmonary arterial hypertension

Nashat, Heba; Montanaro, Claudia; Li, Wei; Kempny, Aleksander; Wort, Stephen J.; Dimopoulos, Konstantinos; Gatzoulis, Michael Α.; Babu‐Narayan, Sonya V.

doi:10.21037/jtd.2018.08.92

Cited by 32 publications

(26 citation statements)

References 68 publications

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“…There are two approaches to management. As described by Nashat et al, safe closure is possible if the net left-to-right shunting is greater than 1.5 and pulmonary vascular resistance is less than 2.3 Wood units, which was not the case in our patient [15]. To our knowledge, elevated liver function tests have not been used as criteria for surgery.…”

Section: Discussionmentioning

confidence: 54%

Secundum Atrial Septal Defect With Early Presentation of Eisenmenger Syndrome and Right-Heart Failure: A Rare Case Report and Literature Review

Malik¹,

Ikram²,

Kamal³

et al. 2020

Cureus

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Eisenmenger syndrome, the most advanced form of pulmonary arterial hypertension (PAH), poses a considerable risk to the survival and quality of life of patients. It is more commonly seen in large intra-cardiac defects like ventricular septal defects (VSD) or patent ductus arteriosus (PDA), and rarely in atrial septal defects (ASD). Early diagnosis is the single most important step in the definitive management of the condition; otherwise, only conservative treatment can be offered. In this report, we present the case of a 20-year-old female patient diagnosed with Eisenmenger syndrome secondary to a large secundum ASD. The patient responded well to medical treatment.

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Section: Discussionmentioning

confidence: 54%

Secundum Atrial Septal Defect With Early Presentation of Eisenmenger Syndrome and Right-Heart Failure: A Rare Case Report and Literature Review

Malik¹,

Ikram²,

Kamal³

et al. 2020

Cureus

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Section: Discussionmentioning

confidence: 99%

“…It is worth noting that other conditions can cause precapillary PH, with the most common being left heart diseases such as diastolic heart failure [8]. Also, precapillary PH in the presence of an ASD can be caused by obstructive lung disease, pulmonary fibrosis, and thromboembolism [8]. The patient in our case had a normal wedge pressure, normal PFT and DLCO, and a step-up of oxygen saturation from high superior vena cavae to the right heart chambers with bidirectional ASD shunting, all pointing towards an ASD as being the primary cause of the PAH.…”

Section: Discussionmentioning

confidence: 99%

“…For patients with PVR between 2.3 and 4.6 WU, the decision to close the ASD is made on a case-by-case basis. Once the shunt has reversed from right to left (Qp : Qs < 1) or is bidirectional (Qp : Qs = 1), PAH is often irreversible and ASD closure is contraindicated due to worsening RHF [6,8]. This is because closing the shunt in such instances may sacrifice the rightsided pressure relief role that the ASD may be providing.…”

Section: Managementmentioning

confidence: 99%

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Atrial Septal Defect with Eisenmenger Syndrome: A Rare Presentation

Forlemu

Ajmal

Saririan

2020

Case Reports in Cardiology

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Atrial septal defects (ASDs) are common congenital heart defects (CHD). The clinical course in patients without closure of the ASD is associated with significant morbidity and mortality in advanced age. A small percentage of patients may develop pulmonary arterial hypertension (PAH) due to left to right shunting that impacts morbidity and mortality. Advances in prenatal screening and fetal echocardiography have allowed timely interventions. Nonetheless, some patients still may be diagnosed with ASD in adulthood as an incidental finding or presenting with clinical symptoms such as shortness of breath from right heart failure. We report a case of an adult female presenting with shortness of breath due to ASD causing PAH with Eisenmenger physiology.

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“…The current gold standard to assess PA pressure to diagnose PAH is using the right heart catheterization (RHC), but TTE is more often used to diagnose PAH because of its availability [11]. This study used TTE as a tool to access the condition of the heart in ASD patients before surgery and at 6 months after surgical closure of ASD.…”

Section: Discussionmentioning

confidence: 99%

Normalization of the right heart and the preoperative factors that influence the emergence PAH after surgical closure of atrial septal defect

Supomo

Widhinugroho

Nugraha

2020

J Cardiothorac Surg

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Background: Surgical closure of atrial septal defect (ASD) is contraindicated in the condition with severe pulmonary arterial hypertension (PAH), whereas ASD closure in an effective intervention to normalize the structure and function of the right heart after previously experiencing volume overload due to shunting from the defect. This study aimed to evaluate normalization of the right heart and emergence of PAH after surgical closure of ASD. Methods: This retrospective study was carried out in 45 patients over 18 years who had undergone surgical closure of ASD. The study has the aim to evaluate the morphological and functional parameters before and after the surgical approach and the preoperative factors that influenced the development of pulmonary arterial hypertension (PAP) after the ASD closure. Results: The majority of subjects were female (73.3%) although there were no significant differences between males and females from the various parameters. The average of mPAP in the group that experienced PAH was higher than non-PAH group after ASD closure (p = 0.019, 31.23 ± 12.70 mmHg vs 24.07 ± 13.08 mmHg). Significant differences were found in the Right Atrium (RA) dimension, Right Ventricle (RV) dimension, Tricuspid Regurgitation Velocity (TRV) and Tricuspid Annular Plane Systolic Excursion (TAPSE) between before and at 6 months after ASD closure (p = 0.000, p = 0.000, p = 0.000, p = 000, respectively). The sensitivity of the predictive model to estimate PAH at 6 months after surgical closure of ASD was 58%, with a specificity of 62.5%. Conclusion: Structural and functional normalization of the right heart occurs at 6 months after surgical closure of ASD with the decrease of RA and RV dimensions and improvement from tricuspid regurgitation. Emergence of PAH after ASD closure was influenced by higher mPAP before surgical approach.

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Atrial septal defects and pulmonary arterial hypertension

Cited by 32 publications

References 68 publications

Secundum Atrial Septal Defect With Early Presentation of Eisenmenger Syndrome and Right-Heart Failure: A Rare Case Report and Literature Review

Secundum Atrial Septal Defect With Early Presentation of Eisenmenger Syndrome and Right-Heart Failure: A Rare Case Report and Literature Review

Atrial Septal Defect with Eisenmenger Syndrome: A Rare Presentation

Normalization of the right heart and the preoperative factors that influence the emergence PAH after surgical closure of atrial septal defect

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