The short- and medium-term results of transcatheter closure of atrial septal defect with severe pulmonary arterial hypertension

Abstract

We investigated the short-term and medium-term results in patients with pulmonary arterial hypertension (PAH) associated with atrial septal defect (ASD) undergoing transcatheter closure. Fifteen patients with severe PAH associated with ASD who underwent successful occluder implantation from 2007 to 2010 were included. Clinical, echocardiographic, and hemodynamic data were reviewed. Severe PAH was defined as pulmonary arterial systolic pressure measured by catheterization was ≥60 mmHg and pulmonary vascular resistance (PVR) ≥6 Wood Units (WU). Compared with baseline, the 6-minwalking distance significantly increased by 29.7 ± 26.3 m (P < 0.001) at 3 months (short-term) and 65.4 ± 63.6 m (P < 0.001) at 23.4 ± 9.7 months (medium-term), World Health Organization function class considerably improved after postclosure short-term and medium-term. Repeat cardiac catheterization (n = 7) showed that mean pulmonary arterial pressure decreased from 51.6 ± 9.4 mmHg at baseline to 21.0 ± 3.8 mmHg (P < 0.001) at follow-up of 12 months. The PVR decreased by 5.6 ± 1.1 WU (P < 0.001). Through carefully selected patients with severe PAH associated with ASD, transcatheter closure can be safely performed with a promising short-term and medium-term outcome. Trial occlusion is an effective way for deciding the reversibility of severe PAH in ASD patients. The role of aerosolized iloprost for pulmonary vasoreactivity testing in patients with severe PAH secondary to ASD requires further investigation.

Time Course of Right Ventricular Remodeling after Percutaneous Atrial Septal Defect Closure: Assessment of Regional Deformation Properties with Two‐Dimensional Strain and Strain Rate Imaging

“…We did not measure the pre‐ and postclosure pulmonary vascular resistance (PVR), however, we have shown a significant decrease in systolic PAP following the defect closure. The decline in systolic PAP together with PVR in closed ASD patients has been reported recently …”

Treat and Repair Strategy in Patients With Atrial Septal Defect and Significant Pulmonary Arterial Hypertension

“…21 However, those investigators excluded patients who were treated with PAH-specific medications. Only a few reports have discussed the effects and safety of transcatheter ASD closure for PAH patients who have been treated with recent disease-targeted therapy for PAH.…”

Comparison of Medium-term Results of Transcatheter Correction Versus Surgical Treatment for Secundum Type Atrial Septal Defect Combined With Pulmonary Valve Stenosis

“…A total of 35 patients (44.9%) underwent percutaneous correction with the SHSMA occluder (Shape Memory Alloy Ltd, Shanghai, China) 12) and PBPV with an Inoue balloon catheter (Toray Industries, Inc., Tokyo) or Cristal balloon (BALT extrusion, France). The remaining 43 patients (55.1%) were treated surgically.…”