title: Atrial septal defect with severe pulmonary hypertension in elderly patients: usefulness of transient balloon occlusion.
abstract: In patients with an atrial septal defect and severe pulmonary hypertension, it is important to determine whether the latter is reversible before percutaneous or surgical closure. In addition to determining pulmonary resistance, one simple technique is to transiently occlude the septal defect using a balloon catheter and to evaluate the hemodynamic response. We defined a positive response as a > or = 25% reduction in mean pulmonary artery pressure during occlusion relative to the basal level, without a fall in systemic pressure or an increase in ventricular end-diastolic pressure. The study included five patients aged over 60 years with an atrial septal defect and severe pulmonary hypertension who were referred for percutaneous closure. In one patient, the test gave a negative result and closure of the atrial septal defect was not performed. In the remaining four, closure was indicated. In three patients, closure was performed percutaneously, while the fourth underwent surgery. The drop in pulmonary pressure observed during the test was maintained over the long term at a mean follow-up time of 22 months.
authors.affiliation: Sección de Hemodinámica y Cardiología Intervencionista, Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. recalde@secardiologia.es
authors.forename: Angel
authors.initials: A
authors.lastname: Sánchez-Recalde
authors.forename: José M
authors.initials: JM
authors.lastname: Oliver
authors.forename: Guillermo
authors.initials: G
authors.lastname: Galeote
authors.forename: Ana
authors.initials: A
authors.lastname: González
authors.forename: Luis
authors.initials: L
authors.lastname: Calvo
authors.forename: Santiago
authors.initials: S
authors.lastname: Jiménez-Valero
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: José L
authors.initials: JL
authors.lastname: López-Sendón
mesh_terms: D000368:Aged; D021721:Balloon Occlusion; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D009569:Nitric Oxide; D011652:Pulmonary Circulation / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide