Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect

Cossio-Aranda, Jorge; Zamora, Karina; Nanda, Navin C.; Uzendu, Anezi; Keirns, Candace; Verdejo-Paris, Juan; Martínez-Ríos, Marco Antonio; Espínola‐Zavaleta, Nilda

doi:10.1111/echo.13358

Cited by 10 publications

(7 citation statements)

References 46 publications

(51 reference statements)

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“…Consistent with past studies, we observed that PH patients had a higher burden of baseline comorbidities than patients without PH. 10,18,30,34,35 Given the scarcity of literature, existing studies are heterogenous in reporting long-term outcomes in this population. Although adverse events were rare, higher rates were observed in patients with PH 20 .…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Adult Patients With Pulmonary Hypertension After Percutaneous Closure of Atrial Septal Defects

Akseer

Abrahamyan

Lee

et al. 2022

Circ: Cardiovascular Interventions

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Background: Pulmonary hypertension (PH), recently redefined as mean pulmonary arterial pressure >20 mm Hg (PH 20 ), may be observed in patients with atrial septal defects (ASD). We aimed to determine the effect of preprocedural PH 20 status on outcomes among patients undergoing ASD closure. Methods: Study population was selected from a retrospective registry of adult patients who underwent percutaneous ASD closure from 1998 to 2016 from a single center and had right heart catheterizations during the procedure. The clinical registry was linked to administrative databases to capture short- and long-term outcomes. Results: We included a total of 632 ASD closure patients of whom 359 (56.8%) had PH 20 . The mean follow-up length was 7.6±4.6 years. Patients with PH 20 were older (mean age 56.5 versus 43.1 years, P <0.001) and a higher prevalence of comorbidities including hypertension (54.3% versus 21.6%, P <0.001) and diabetes (18.1% versus 5.9%, P <0.001) than those without PH. In a Cox proportional hazards model after covariate adjustment, patients with PH had a significantly higher risk of developing major adverse cardiac and cerebrovascular events (heart failure, stroke, myocardial infarction, or cardiovascular mortality), with hazards ratio 2.45 (95% CI, 1.4–4.4). When applying the prior, mean pulmonary arterial pressure ≥25 mm Hg (PH 25 ) cutoff, a significantly higher hazard of developing major adverse cardiac and cerebrovascular events was observed in PH versus non-PH patients. Conclusions: ASD patients with PH undergoing closure suffer from more comorbidities and worse long-term major adverse cardiac and cerebrovascular events outcomes, compared with patients without PH. The use of the new PH 20 definition potentially dilutes the effect of this serious condition on outcomes in this population.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Adult Patients With Pulmonary Hypertension After Percutaneous Closure of Atrial Septal Defects

Akseer

Abrahamyan

Lee

et al. 2022

Circ: Cardiovascular Interventions

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“…Clinical and diagnostic characteristics supported distinct hemodynamic properties between groups whom similar to other studies though no difference in size defect was found between groups. Conflicting findings in other studies exist regarding PH severity and defect size ( 16 , 17 ). Determination of defect size in available studies was done using echocardiography where the accuracy of the results depends on the view taken, the form of ASD, as well as individual expertise.…”

Section: Discussionmentioning

confidence: 70%

Operability of atrial septal defect with borderline pulmonary vascular resistance index: A study in developing country

Lilyasari

Istisakinah²,

Ariani³

et al. 2022

Front. Surg.

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BackgroundPulmonary arterial hypertension secondary to atrial septal defect (ASD) is an important determinant of morbidity and mortality in defect closure. We aimed to compare perioperative outcome between preoperative borderline and low pulmonary vascular resistance index (≥4 WU.m2 and <4 WU.m2, respectively) in surgical closure of secundum atrial septal defect with concomitant pulmonary arterial hypertension.Methods and resultsThis was a single-center retrospective cohort study between January 2015 and January 2020. We classified patients with low and borderline PVRI who underwent ASD closure and recorded the perioperative outcomes.ResultsWe analyzed a total of 183 patients with atrial septal defect and pulmonary arterial hypertension; 92 patients with borderline PVRI and 91 patients with low PVRI. Borderline pulmonary vascular resistance index was not associated with increased risk of postoperative mortality (p = 0.621; OR0.48, 95% CI 0.04–5.48), but associated with higher risk of overall morbidity in bivariate analysis (p = 0.002; OR3.28, 95% CI 1.5–6.72). Multivariate analysis showed positive association of borderline pulmonary vascular resistance index (p = 0.045; OR2.63, 95% CI 1.02–6.77) and preoperative tricuspid valve gradient ≥64 mmHg (p = 0.034; OR2.77, 95% CI 1.08–7.13) with overall morbidity.ConclusionThere is no difference in incidence of in-hospital mortality between preoperative borderline and low pulmonary vascular resistance index patients. However, preoperative borderline pulmonary vascular resistance index and tricuspid valve gradient ≥64 mmHg are associated with increased overall morbidity after surgical closure in secundum atrial septal defect patients with pulmonary arterial hypertension.

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“…However, in large defects (>1.5 cm) all develop the syndrome in time, if there is no intervention. For ASDs, a recent publication demonstrates the same finding, that defects most likely to have severe PAH were the largest (31.84 ± 8.21 mm) [ 12 ]. More complex lesions such as atrioventricular septal defects or truncus arteriosus often develop PAH early in life.…”

Section: Causes and Pathophysiologymentioning

confidence: 82%

Pulmonary Hypertension in Congenital Heart Disease

Pascall

Tulloh

2018

Future Cardiol.

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Pulmonary hypertension is defined as a mean pulmonary arterial pressure ≥25 mmHg. We focus on its relevance in congenital heart disease, reviewing pathophysiology, diagnosis and management. Pulmonary hypertension is a relatively common complication of congenital heart disease, with adult prevalence between 5 and 10%. A multifactorial cause is recognized, relating to the size and nature of cardiac defect as well as environmental and genetic factors. More complex disease is increasingly recognized rather than pure Eisenmenger complex. Remodeling of the pulmonary vascular bed causes increased pulmonary vascular resistance diagnosed by a collection of investigations including echocardiography, exercise testing, cardiac catheterization, MRI and CT scanning. Management employs disease-modifying medications which are now used with increasing benefit.

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Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect

Cited by 10 publications

References 46 publications

Long-Term Outcomes in Adult Patients With Pulmonary Hypertension After Percutaneous Closure of Atrial Septal Defects

Long-Term Outcomes in Adult Patients With Pulmonary Hypertension After Percutaneous Closure of Atrial Septal Defects

Operability of atrial septal defect with borderline pulmonary vascular resistance index: A study in developing country

Pulmonary Hypertension in Congenital Heart Disease

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