title: Atrial septal defect closure with an Amplatzer septal occluder fenestrated with a coronary stent in a child with pulmonary arterial hypertension.
abstract: The presence of an atrial septal defect in pulmonary hypertension has benefits and detractions. Even in idiopathic pulmonary arterial hypertension, a significant left-to-right shunt at atrial level may increase the pulmonary arterial pressure and exacerbate the disease. However, it is well recognised that the presence of an atrial communication may be protective in subgroups with severe disease, allowing maintenance of cardiac output during times of increased pulmonary resistance. In the present paper, we present the case of a young boy with significant idiopathic pulmonary arterial hypertension and an atrial septal defect. We report our technique of septal occlusion using a device to decrease left-to-right shunting with concomitant stent insertion in that device to maintain the potential for right-to-left shunting during times of high pulmonary arterial pressure.
authors.affiliation: Department of Paediatric Cardiology, Bristol Children's Hospital, Bristol, London, UK.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Skinner
authors.forename: Robert M
authors.initials: RM
authors.lastname: Tulloh
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tometzki
authors.forename: Ingram
authors.initials: I
authors.lastname: Schulze-Neick
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Morgan
mesh_terms: D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D002648:Child; D065627:Familial Primary Pulmonary Hypertension; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000601:surgery*; D008297:Male; D055989:Septal Occluder Device; D015607:Stents; D016896:Treatment Outcome