Effect on right ventricular volume of percutaneous Amplatzer closure of atrial septal defect in adults

Schussler, Jeffrey M.; Anwar, Azam; Phillips, Sabrina D.; Roberts, Brad J.; Vallabhan, Ravi C.; Grayburn, Paul A.

doi:10.1016/j.amjcard.2004.12.046

Cited by 39 publications

(19 citation statements)

References 17 publications

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“…Positive remodeling changes may be appreciable as early as 24 hours post-ASD closure. 19,27,28 Benefits are less pronounced in patients with higher degrees of PAH, potentially reflecting residual defects with permanent structural changes.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Arterial Hypertension in Patients With Transcatheter Closure of Secundum Atrial Septal Defects

Yong

Khairy

Guise

et al. 2009

Circ: Cardiovascular Interventions

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Background— Pulmonary arterial hypertension (PAH) may develop in patients with atrial septal defects (ASD); however, little is known about associated risk factors and its evolution after transcatheter ASD closure. Methods and Results— We conducted a cohort study on 215 adults with attempted transcatheter ASD closure from 1999 to 2006. Patients were classified according to baseline systolic pulmonary artery pressures as having no (I, <40 mm Hg), mild (II, 40 to 49 mm Hg), moderate (III, 50 to 59 mm Hg), or severe (IV, ≥60 mm Hg) PAH. Independent predictors of moderate or severe PAH were older age (odds ratio [OR], 1.10 per year; P <0.0001), larger ASD (OR, 1.13 per millimeter; P =0.0052), female sex (OR, 3.9; P =0.0313), and at least moderate tricuspid regurgitation (OR, 3.6; P =0.0043). At 15 (interquartile range, 8 to 43) months post–ASD closure, patients with higher baseline pressures were more likely to experience a ≥5-mm Hg decrease (33.7%, 73.9%, 79.2%, and 100.0% in groups I to IV, P <0.0001), with a larger magnitude of reduction (0, 8, 17, and 22 mm Hg; P <0.0001). However, normalization of pressures (<40 mm Hg) occurred less frequently in patients with more advanced PAH (90.2%, 71.7%, 66.7%, and 23.5%, P <0.0001). Among patients with moderate or severe PAH, independent predictors of normalization were lower baseline pressures (OR, 0.91 per mm Hg; P =0.0418) and no more than mild tricuspid regurgitation (OR, 0.14; P =0.0420). Conclusion— In adults with ASDs, severity of PAH is modulated by age, sex, defect size, and degree of tricuspid regurgitation. Patients with moderate or severe PAH may benefit from substantial reductions in pulmonary artery pressures after transcatheter ASD closure, although the PAH values remain elevated in a sizeable proportion.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Arterial Hypertension in Patients With Transcatheter Closure of Secundum Atrial Septal Defects

Yong

Khairy

Guise

et al. 2009

Circ: Cardiovascular Interventions

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“…Está bem demonstrado que o remodelamento precoce ocorre nos primeiros dias após o fechamento percutâneo do defeito, com quedas drásticas no tamanho do ventrículo direito mensuradas através do modo-M ou estimativa do volume ventricular, tanto em crianças como em adultos. [44][45][46][47] Essas alterações atingem valores dentro da normalidade na maioria dos pacientes em até um mês após o procedimento percutâneo. 48 Entretanto, séries de pacientes submetidos a reparo cirúrgico são controversas quanto a esse processo, mesmo após alguns anos do procedimento.…”

Section: Base Racional Para Utilização Da Tecnologiaunclassified

Oclusão percutânea de comunicação interatrial pelo sistema único de saúde: uma opção economicamente viável

Filho¹,

Mânica²,

Cardoso³

2010

Rev. Bras. Cardiol. Invasiva

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A comunicação interatrial (CIA) é uma das malformações congênitas mais frequentes, representando aproximadamente 5% a 10% de todos os defeitos cardíacos congêni-tos. O tipo mais comum é a CIA ostium secundum (CIA OS), que representa cerca de 75% dessas malformações. Quando descoberta tardiamente ou na ausência de tratamento, além da alteração no exame clínico, pode existir insuficiên-cia cardíaca, arritmias cardíacas, insuficiência mitral, sobrecarga ventricular direita e hipertensão pulmonar. Em casos avançados com hipertensão pulmonar grave e reversão do shunt interatrial (direita para esquerda) instala-se a cianose, o que indica doença cardiopulmonar grave e mortalidade aumentada. Nas últimas décadas, com o aprimoramento das técnicas e dos dispositivos percutâneos, as possibilidades de tratamento dos defeitos congênitos por via percutânea têm crescido vertiginosamente. Vários estudos já demonstraram os excelentes resultados imediatos e a longo prazo da atriosseptoplastia percutânea. Além de proporcionar maior conforto ao paciente, menores taxas de complicações, menor tempo de recuperação intra e extra-hospitalar e eficácia similar à da atriosseptoplastia cirúrgica, em países desenvolvidos, é comprovadamente a opção mais econômica. Não há dúvidas de que, em futuro próximo, a relação custoefetividade desse procedimento será observada também em países em desenvolvimento como o Brasil, em que o custo da prótese, ainda hoje, é o principal obstáculo para a padronização desse procedimento, e em que os valores pagos pelos procedimentos cirúrgicos continuam muito defasados. DESCRITORES:Comunicação interatrial. Cardiopatias congênitas. Próteses e implantes. ABSTRACT Percutaneous Closure of Atrial Septal Defects by the Brazilian Health System: an Economically Feasible OptionAtrial septal defect (ASD) is one of the most frequent congenital malformations, representing 5% to 10% of all congenital heart defects. The most common type is the ostium secundum ASD (OS ASD), and represents 75% of these malformations. When diagnosed late or left untreated, in addition to abnormalities in the clinical examination, there may be heart failure, cardiac arrhythmias, mitral insufficiency, right ventricular overload and pulmonary hypertension. In advanced cases with severe pulmonary hypertension and interatrial shunt reversal (right to left), there is cyanosis, which indicates severe cardiopulmonary disease and increased mortality. In the last decades, with the improvement of percutaneous techniques and devices, the possibility of percutaneous treatment of congenital defects has increased dramatically. Several studies have shown excellent early and long-term results of percutaneous atrial septoplasty. In addition to providing greater comfort for patients, lower complication rates, less in-hospital and extra-hospital recovery time and efficacy similar to that of surgical atrial septoplasty in developed countries, it is definitely the most economic option. There is no doubt that in the near future, the cost-effectiveness ratio of this proc...

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“…47,[52][53][54][55] Reduced right atrial and ventricular volumes are apparent within 24 hours, and probably earlier.…”

Section: Cardiac Remodelingmentioning

confidence: 99%

Atrial Septal Defects in the Adult

2006

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Effect on right ventricular volume of percutaneous Amplatzer closure of atrial septal defect in adults

Cited by 39 publications

References 17 publications

Pulmonary Arterial Hypertension in Patients With Transcatheter Closure of Secundum Atrial Septal Defects

Pulmonary Arterial Hypertension in Patients With Transcatheter Closure of Secundum Atrial Septal Defects

Oclusão percutânea de comunicação interatrial pelo sistema único de saúde: uma opção economicamente viável

Atrial Septal Defects in the Adult

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