Progressive Pulmonary Hypertension Post Atrial Septal Defect Device Closure—Early Symptomatic Improvement may not Predict Outcome

O’Donnell, Clare; Ruygrok, Peter; Whyte, K.; Wilson, Nigel

doi:10.1016/j.hlc.2010.08.010

Cited by 13 publications

(4 citation statements)

References 14 publications

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“… 1 Previous studies reported that shunt closure did not always improve PAH. 20 21 Patients who developed PAH after shunt closure had a worse prognosis compared with those treated with medical therapy. 22 23 Therefore, ASD closure has been considered to be unsuitable in patients with PAH.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension

Takaya

Akagi

Sakamoto

et al. 2021

Heart

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ObjectiveTherapeutic strategies for atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) are controversial. This study aimed to evaluate the efficacy of PAH-specific medications and subsequent transcatheter closure (ie, treat-and-repair strategy) on clinical outcomes.MethodsWe enrolled 42 patients who were referred to 13 institutions for consideration of ASD closure with concomitant PAH and underwent the treat-and-repair strategy. The endpoint was cardiovascular death or hospitalisation due to heart failure or exacerbated PAH.ResultsAt baseline prior to PAH-specific medications, pulmonary to systemic blood flow ratio (Qp:Qs), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (PAP) were 1.9±0.8, 6.9±3.2 Wood units and 45±15 mm Hg. Qp:Qs was increased to 2.4±1.2, and PVR and mean PAP were decreased to 4.0±1.5 Wood units and 35±9 mm Hg at the time of transcatheter ASD closure after PAH-specific medications. Transcatheter ASD closure was performed without any complications. During a median follow-up period of 33 months (1–126 months) after transcatheter ASD closure, one older patient died and one patient was hospitalised due to heart failure, but the other patients survived with an improvement in WHO functional class. PAP was further decreased after transcatheter ASD closure.ConclusionsThe treat-and-repair strategy results in low complication and mortality rates with a reduction in PAP in selected patients with ASD complicated with PAH who have a favourable response of medical therapy.

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Section: Discussionmentioning

confidence: 99%

Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension

Takaya

Akagi

Sakamoto

et al. 2021

Heart

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“…Several cases of late (several years after surgery) mortality were reported by Horer et al They found that pre-operative systolic pulmonary artery pressure greater than 36 millimetres of mercury, and mean pulmonary artery pressure greater than 21 millimetres of mercury were predictive of late death from arrhythmia or cardiac failure 18 . In 11 patients with mean pulmonary artery pressure greater than or equal to 30 millimetres of mercury before transcatheter atrial septal defect closure, two patients developed progressive pulmonary vascular disease with one death 19 …”

Section: Pulmonary Hypertension After Atrial Septal Defect Closurementioning

confidence: 93%

“…18 In 11 patients with mean pulmonary artery pressure greater than or equal to 30 millimetres of mercury before transcatheter atrial septal defect closure, two patients developed progressive pulmonary vascular disease with one death. 19 We were ready to add sildenafil to our patient's therapy, but on serial echocardiograms post-atrial septal defect closure her pulmonary artery systolic pressure did not exceed 45-50 millimetres of mercury with further decrease after delivery.…”

Section: Pulmonary Hypertension After Atrial Septal Defect Closurementioning

confidence: 93%

Surgical repair of atrial septal defect with severe pulmonary hypertension during pregnancy: a case report with literature review

et al. 2012

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We are reporting a case of a 37-year-old pregnant woman with a large secundum atrial septal defect with left-to-right shunt and severe pulmonary hypertension. Her atrial septal defect was undiagnosed before this pregnancy. After carefully considering all the options, we repaired her atrial septal defect with an open heart surgical closure at 20 weeks of gestation. A substantial and consistent reduction in pulmonary arterial pressure after the surgery and subsequent uneventful delivery indicate that surgical repair of atrial septal defects is a viable option that should be considered for such patients.

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“…The optimal management of patients with ASD and PAH is controversial [2,3]. When the PAH is severe, surgical closure has produced poor outcomes [4][5][6], whereas transcatheter closure after lung transplantation (transplant-and-repair strategy) has been found beneficial [7].…”

mentioning

confidence: 99%

Percutaneous atrial septal defect closure in patients with pulmonary arterial hypertension

Valdeolmillos,

Foray,

Albenque

et al. 2024

Eur Respir J

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Progressive Pulmonary Hypertension Post Atrial Septal Defect Device Closure—Early Symptomatic Improvement may not Predict Outcome

Cited by 13 publications

References 14 publications

Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension

Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension

Surgical repair of atrial septal defect with severe pulmonary hypertension during pregnancy: a case report with literature review

Percutaneous atrial septal defect closure in patients with pulmonary arterial hypertension

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