title: 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.
authors.affiliation: Congenital Heart Center, Department of Cardiovascular Medicine, The First Affiliated Hospital of Harbin Medical University, No 23 Youzheng Street, Nangang District, Harbin, 150001, China.
authors.forename: Zhi-wei
authors.initials: ZW
authors.lastname: Huang
authors.forename: Zhi-xin
authors.initials: ZX
authors.lastname: Fan
authors.forename: Jian-tao
authors.initials: JT
authors.lastname: Sun
authors.forename: Wei-min
authors.initials: WM
authors.lastname: Li
authors.forename: Yan-qing
authors.initials: YQ
authors.lastname: Gao
authors.forename: Yi-hua
authors.initials: YH
authors.lastname: Quan
authors.forename: Ya-ming
authors.initials: YM
authors.lastname: Geng
authors.forename: Yan-yan
authors.initials: YY
authors.lastname: Niu
authors.forename: Bing-xiang
authors.initials: BX
authors.lastname: Wu
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols; D000368:Aged; D062186:Arterial Pressure; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002407:Catheterization, Swan-Ganz; D016009:Chi-Square Distribution; D005080:Exercise Test; D017079:Exercise Tolerance; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016285:Iloprost / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D020127:Recovery of Function; D012189:Retrospective Studies; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014655:Vascular Resistance; D016138:Walking; D055815:Young Adult
chemical_list: D000336:Aerosols; D016285:Iloprost