Latent pulmonary hypertension in atrial septal defect: Dynamic stress echocardiography reveals unapparent pulmonary hypertension and confirms rapid normalisation after ASD closure

The aim of the study was to review our experience with atrial septal defect (ASD) closure with a fenestrated patch in patients with severe pulmonary hypertension. Between July 2004 and February 2009, 16 patients with isolated ASD underwent closure with a fenestrated patch. All patients had a secundum type ASD and severe pulmonary hypertension. Patients ranged in age from 6 to 57 years (mean � SD, 34.9 � 13.5 years). The follow-up period was 9 to 59 months (mean, 34.5 � 13.1 months). The ranges of preoperative systolic and pulmonary arterial pressures were 63 to 119 mm Hg (mean, 83.8 � 13.9 mm Hg) and 37 to 77 mm Hg (mean, 51.1 � 10.1 mm Hg). The ranges of preoperative values for the ratio of the pulmonary flow to the systemic flow and for pulmonary arterial resistance were 1.1 to 2.7 (mean, 1.95 � 0.5) and 3.9 to 16.7 Wood units (mean, 9.8 � 2.9 Wood units), respectively. There was no early or late mortality. Tricuspid annuloplasty was performed in 14 patients (87.5%). The peak tricuspid regurgitation gradient and the ratio of the systolic pulmonary artery pressure to the systemic arterial pressure were decreased in all patients. The New York Heart Association class and the grade of tricuspid regurgitation were improved in 13 patients (81.2%) and 15 patients (93.7%), respectively. ASD closure in patients with severe pulmonary hypertension can be performed safely if we create fenestration. Tricuspid annuloplasty and a Cox maze procedure may improve the clinical result. Close observation and follow-up will be needed to validate the long-term benefits.

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Prevalence and outcomes of pulmonary hypertension after percutaneous closure of atrial septal defect: a systematic review and meta-analysis

European Respiratory Review ◽

10.1183/16000617.0099-2020 ◽

2020 ◽

Vol 29 (158) ◽

pp. 200099

Author(s):

Selai Akseer ◽

Eric Horlick ◽

Varnita Vishwanath ◽

Benjamin Hobbes ◽

Ella Huszti ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Meta Analysis ◽

Case Series ◽

Mean Difference ◽

Eligibility Criteria ◽

Standard Mean Difference ◽

Asd Closure ◽

Meta Analyses

BackgroundAtrial septal defect (ASD) is a common form of congenital heart disease. Significant shunts may increase the risk of developing pulmonary hypertension (PH). We aimed to describe current PH definitions, evaluate PH prevalence and the effect of PH on outcomes in patients undergoing percutaneous ASD closure.MethodsEMBASE, MEDLINE and Cochrane databases were systematically searched. Studies reporting PH prevalence or mean systolic pulmonary arterial pressure (sPAP) before and after percutaneous ASD closure in adults were included. We conducted meta-analyses to obtain summary estimates for PH prevalence and mean sPAP.Results15 articles with a total of 1073 patients met the eligibility criteria. Studies applied variable PH definitions. PH prevalence and mean sPAP levels decreased in all studies after closure. The pooled PH prevalence decreased from 44% (95% CI 29–60%) to 18% (95% CI 8–27%). The overall standardised mean difference in sPAP was 1.12 (95% CI 0.81–1.44) and 1.62 (95% CI 1.00–2.23) in cohort and case-series studies respectively indicating a large decrease. The pooled standard mean difference among the younger and older patients were different, 1.25 (95% CI 0.78–1.71) and 0.91 (95% CI 0.56–1.27), respectively. A high degree of between-study heterogeneity was noted.ConclusionsBoth PH prevalence and mean sPAP decrease after ASD closure. Larger, prospective studies with consistent PH definitions using the recommended measurement modality are warranted.

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Atrial septal defect closure in a midget toy poodle

Open Veterinary Journal ◽

10.4314/ovj.v10i1.3 ◽

2020 ◽

Vol 10 (1) ◽

pp. 11-15

Author(s):

Keisuke Sugimoto ◽

Yohei Mochizuki ◽

Teppei Kanda ◽

Akihiro Ohnishi ◽

Masahiro Miyabe ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Hybrid Approach ◽

Atrial Septal Defect Closure ◽

Congenital Cardiac Disease ◽

Atrial Enlargement ◽

Flow Through ◽

Asd Closure ◽

Cardiac Enlargement

Background: Atrial septal defect (ASD) is a rare congenital cardiac disease, and there have been no reports about the treatment of ASD in midget breed dogs.Case Description: A 7-month-old female toy poodle weighing 1.4 kg presented with cardiac enlargement. Echocardiography revealed a secundum-type ASD, right ventricular and atrial enlargement, and pulmonary hypertension. Blood flow through the ASD exhibited left-to-right shunting. The dog underwent ASD closure through a hybrid approach, in conjunction with catheter techniques and thoracotomy. Ten months after treatment, cardiac enlargement and pulmonary hypertension were improved.Conclusion: Even in midget dog breeds, ASD can be corrected through a hybrid approach. Keywords: Canine, Cardiology, Catheter, Congestive heart failure, Small breed.

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337 Do patients with severe pulmonary hypertension profit from interventional closure of Atrial Septal Defect II (ASD II)?

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(04)90247-0 ◽

2004 ◽

Vol 3 (1) ◽

pp. 85

Author(s):

M RESCHKE

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Severe Pulmonary Hypertension ◽

Interventional Closure

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Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

The Heart Surgery Forum ◽

10.1532/hsf98.20041173 ◽

2005 ◽

Vol 8 (2) ◽

pp. 96 ◽

Cited By ~ 1

Author(s):

Osman Tansel Dar�in ◽

Alper Sami Kunt ◽

Mehmet Halit Andac

Keyword(s):

Atrial Septal Defect ◽

Right Atrium ◽

Septal Defect ◽

Complete Recovery ◽

Interatrial Septum ◽

Right Atrial ◽

Atrial Wall ◽

Residual Shunt ◽

Asd Closure ◽

The Right

Background: Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. Case: In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. Results: During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. Conclusion: Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

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Acute Changes in Left Ventricular End Diastolic Pressure following the Transcatheter Closure of an Atrial Septal Defect in Adults

The Heart Surgery Forum ◽

10.1532/hsf.1442 ◽

2016 ◽

Vol 19 (3) ◽

pp. 145 ◽

Cited By ~ 1

Author(s):

Young Hwa Kong ◽

Jinyoung Song ◽

Kyung Hee Kim ◽

June Huh ◽

I-Seok Kang

Keyword(s):

Elderly Patients ◽

Atrial Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Diastolic Pressure ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

Device Closure ◽

Acute Changes ◽

Asd Closure

Background: Acute changes in left ventricular diastolic function shortly after ASD closure in elderly patients have not been well known. We aimed to investigate acute changes in left ventricular end diastolic pressure (LVEDP) in elderly patients following transcatheter closure of atrial septal defect (ASD). Methods: All 19 adults with ASDs who underwent transcatheter closure between June 2013 and December 2014 were enrolled. LVEDP was measured prior to device closure and compared with that immediately following device closure and 15 minutes after device closure. Results: The median age of the patients was 48 years old. The baseline E/e’ and LVEDP values were 8.3 ± 2.8 and 13 ± 3 mmHg. The LVEDP value immediately following closure was 19 ± 4 mmHg, and 15 minutes after closure was 16 ± 4 mmHg. The median increase in the LVEDP value immediately following closure was 6 mmHg, which significantly differed from that prior to closure. The LVEDP 15 minutes after closure decreased but remained significantly higher than the value observed immediately after closure. No significant changes were observed with regard to E/e’ at either 1 day or 3 months following closure. The LVEDP value 15 minutes after device closure was significantly correlated with those observed before closure and immediately following closure; however, no significant correlations were observed with regard to patient age, Qp/Qs, E/e’ before closure, or E/e’ 3 months after device closure. Conclusion: LVEDP in adults with ASDs significantly increases following device closure. LVEDP before closure predicts LVEDP following device closure.

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Heart and lung transplantation in pulmonary arterial hypertension related to congenital heart disease: an unusual indication

Journal of Congenital Cardiology ◽

10.1186/s40949-020-00047-7 ◽

2020 ◽

Vol 4 (S1) ◽

Author(s):

Rosaria Barracano ◽

Heba Nashat ◽

Andrew Constantine ◽

Konstantinos Dimopoulos

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Lung Transplantation ◽

Atrial Septal Defect ◽

Septal Defect ◽

Pulmonary Vascular Disease ◽

Eisenmenger Syndrome ◽

Pulmonary Arterial ◽

Recurrent Haemoptysis

Abstract Background Eisenmenger syndrome is a multisystem disorder, characterised by a significant cardiac defect, severe pulmonary hypertension and long-standing cyanosis. Despite the availability of pulmonary hypertension therapies and improved supportive care in specialist centres, Eisenmenger patients are still faced with significant morbidity and mortality. Case presentation We describe the case of a 44-year-old woman with Eisenmenger syndrome secondary to a large secundum atrial septal defect. Her pulmonary vascular disease was treated with pulmonary vasodilators, but she experienced a progressive decline in exercise tolerance, increasing atrial arrhythmias, resulting in referral for transplantation. Her condition was complicated by significant recurrent haemoptysis in the context of extremely dilated pulmonary arteries and in-situ thrombosis, which prompted successful heart and lung transplantation. She made a slow recovery but remains well 3 years post-transplant. Conclusions Patients with Eisenmenger syndrome secondary to a pre-tricuspid lesion, such as an atrial septal defect have a natural history that differs to patients with post-tricuspid shunts; the disease tends to present later in life but is more aggressive, prompting early and aggressive medical intervention with pulmonary arterial hypertension therapies. This case illustrates that severe recurrent haemoptysis can be an indication for expediting transplantation in Eisenmenger syndrome patients.

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Pulmonary Vascular Disease in Secundum Atrial Septal Defect with Pulmonary Hypertension

CHEST Journal ◽

10.1378/chest.89.5.694 ◽

1986 ◽

Vol 89 (5) ◽

pp. 694-698 ◽

Cited By ~ 32

Author(s):

Shigeo Yamaki ◽

Togo Horiuchi ◽

Makoto Miura ◽

Yasuyuki Suzuki ◽

Eiji Ishizawa ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Vascular Disease ◽

Septal Defect ◽

Pulmonary Vascular Disease ◽

Secundum Atrial Septal Defect

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ATRIAL SEPTAL DEFECT- INDUCED PARTIALLY REVERSIBLE SEVERE PULMONARY HYPERTENSION: WHAT SHOULD WE DO?

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)31098-1 ◽

2016 ◽

Vol 67 (13) ◽

pp. 1097

Author(s):

Mugurel Valentin Bazavan ◽

Abdalla Hassan ◽

Maria Bazavan ◽

Susheela Hadigal ◽

Sorin Danciu

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Severe Pulmonary Hypertension

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Abstract 2130: Long-term Outcomes of Adult Atrial Septal Defect With Severe Pulmonary Hypertension After Surgical Closure

Circulation ◽

10.1161/circ.116.suppl_16.ii_461-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jeong-Hoon Kim ◽

Duk-Hyun Kang ◽

Jong-Young Lee ◽

Jong-Min Song ◽

Tae-Jin Yun ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Elderly Patients ◽

Atrial Septal Defect ◽

Septal Defect ◽

Survival Rates ◽

Severe Pulmonary Hypertension ◽

Term Survival ◽

Surgical Closure

The benefits of surgical closure has been unclear in adult atrial septal defect (ASD) with severe pulmonary hypertension (PHT), and we tried to evaluate improvement of PHT and long-term survival after surgical closure compared to medical follow-up. Methods: From 1996 to 2006, we included a total of 71 adult ASD patients (age; 43±15 years) with severe PHT documented by echocardiography. The inclusion criteria were defined as ASD diameter > 15 mm, enlarged right ventricle, and the baseline peak velocity of tricuspid regurgitation (TR) ≥ 4.0 m/sec. We excluded 5 patients with Eisenmenger syndrome documented by cardiac catheterization. Surgical closure was performed on 55 patients (OP group) and the remaining 16 patients were followed up medically (MED group). The improvement of PHT was defined as TR velocity ≤ 3.5 m/sec on follow-up echo. Results: Baseline characteristics and clinical results were compared between the two groups in table . There were no significant differences in terms of gender, ASD diameter, cardiac rhythm, and TR velocity, but the MED group was significantly older. During follow-up of 46±33 months, there were 5 deaths in the MED group and no operative or late death in the OP group, and the 5-year actuarial survival rate of the OP group was significantly higher than the MED group (58±15%, p<0.05). On subgroup analysis according to age, the OP group showed significantly better survival rates than the MED group (p<0.05) in elderly patients (age > 50). In the OP group, TR velocity was significantly decreased from 4.5±0.4 to 3.0±0.7 m/sec on follow-up echo, and improvement of PHT was observed in 47 (85%) patients. On multivariate analysis, female gender and lower baseline TR velocity were the significant independent predictors of improved PHT after surgery. Conclusions: In adult ASD with severe PHT, surgical closure can be safely performed and improve PHT effectively. Especially in elderly patients, ASD closure is significantly related with the better survival rates.

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