Atrial septal defect closure in a patient with "irreversible" pulmonary hypertensive arteriopathy.
The presence of irreversible pulmonary hypertension in patients with atrial septal defect (ASD) is thought to preclude shunt closure. We report the case of a woman with plexiform pulmonary arteriopathy secondary to an ostium secundum ASD who was able to successfully undergo percutaneous shunt closure following therapy with chronic intravenous prostacyclin (Flolan). One year after closure, the patient was weaned off Flolan over a period of 7 months following the institution of oral Bosentan therapy. Our case illustrates how aggressive vasodilator therapy with prostaglandins may be capable of reducing pulmonary artery pressure and permitting shunt closure in a patient once considered to have "inoperable" pulmonary arteriopathy.
Schwerzmann
Markus
M
Zafar
Moiz
M
McLaughlin
Peter R
PR
Chamberlain
Dean W
DW
Webb
Gary
G
Granton
John
J
D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D006328:Cardiac Catheterization; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy*; D007262:Infusions, Intravenous; D011651:Pulmonary Artery
D000959:Antihypertensive Agents; D011464:Epoprostenol