title: A different view on predictors of pulmonary hypertension in secundum atrial septal defect.
abstract: OBJECTIVE
  Pulmonary arterial hypertension is an important complication in hemodynamically relevant atrial septal defects (ASD) and negatively affects outcome. This retrospective study aimed at (1) estimating the prevalence of pulmonary hypertension (PH) in patients with secundum ASD and (2) identifying predictors of PH development or persistence after ASD closure.
  
  
  METHODS
  Consecutive patients with an isolated secundum ASD from the Belgian Registry on Adult Congenital Heart Disease were studied. Demographic, clinical, echocardiographic and invasive hemodynamic measurements were analyzed. PH was defined upon the echocardiographic PH probability (tricuspid regurgitation velocity≥2.9 m/s).
  
  
  RESULTS
  PH prevalence in the entire ASD population (295 patients, 68.8% females, mean age 46±21 years) was 15.9% compared to 13.3% in patients after ASD closure. PH after ASD closure was significantly related to mortality (p=0.001), atrial arrhythmia (p<0.001) and right heart failure (p=0.019). Age at repair was the most important predictor for PH (HR 1.11). In the highest tertile of age at repair (>55 years), PH prevalence was the highest (34%) and mean pulmonary artery pressure (mPAP) at catheterization before was related to PH after closure (HR 1.09). Twenty patients in the PH group had mPAP<25 mmHg before closure.
  
  
  CONCLUSIONS
  PH in closed secundum ASD patients is not uncommon. Its prevalence was the highest when the defect was repaired above 55 years of age. Clinical outcome was worse. PH may even develop despite normal mPAP before closure. The present findings raise the question whether the cutoff value for mPAP before closure should be age-adjusted.
authors.affiliation: University Hospitals Leuven, Belgium.
authors.forename: Charlien
authors.initials: C
authors.lastname: Gabriels
authors.affiliation: University Hospitals Leuven, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: De Meester
authors.affiliation: University Hospitals St Luc Brussels, Belgium.
authors.forename: Agnes
authors.initials: A
authors.lastname: Pasquet
authors.affiliation: University Hospital Ghent, Belgium.
authors.forename: Julie
authors.initials: J
authors.lastname: De Backer
authors.affiliation: University Hospital Antwerp, Belgium.
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Paelinck
authors.affiliation: Brugmann University Hospital Brussels, Belgium.
authors.forename: Marielle
authors.initials: M
authors.lastname: Morissens
authors.affiliation: University Hospitals Leuven, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Van De Bruaene
authors.affiliation: University Hospitals Leuven, Belgium.
authors.forename: Marion
authors.initials: M
authors.lastname: Delcroix
authors.affiliation: University Hospitals Leuven, Belgium. Electronic address: werner.budts@uzleuven.be.
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
keywords: Atrial septal defect; Epidemiology; Hemodynamics; Prognosis; Pulmonary hypertension