title: Pulmonary arterial hypertension in patients with transcatheter closure of secundum atrial septal defects: a longitudinal study.
abstract: 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.
  
  
  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, >or=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 >or=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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Canada.
authors.forename: Gerald
authors.initials: G
authors.lastname: Yong
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Pierre
authors.initials: P
authors.lastname: De Guise
authors.forename: Annie
authors.initials: A
authors.lastname: Dore
authors.forename: Francois
authors.initials: F
authors.lastname: Marcotte
authors.forename: Lise-Andree
authors.initials: LA
authors.lastname: Mercier
authors.forename: Stephane
authors.initials: S
authors.lastname: Noble
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D006328:Cardiac Catheterization; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D012737:Sex Factors; D014262:Tricuspid Valve Insufficiency / Q000150:complications; D014463:Ultrasonography