title: Transcatheter closure of five atrial septal communications in the presence of severe pulmonary arterial hypertension and severe left ventricular non-compliance.
abstract: Closure of congenital atrial communications in the presence of either severe pulmonary arterial hypertension (PAH) with pulmonary-to-systemic (right-to-left) shunting, or severe left ventricular (LV) non-compliance with left-to-right shunting is often considered prohibitive. Thus, the recognition of durable reversibility of these physiologic conditions is crucial. We describe a hemodynamic conundrum in a patient with five septal communications in whom the coexistence of unmasked bidirectional physiologic shunting, severe PAH, and worsening left-sided overload dissuaded initial closure. We report our strategy for hemodynamic evaluation and successful closure of all defects.
authors.affiliation: Division of Cardiovascular Medicine, University of Louisville School of Medicine, Rudd Heart and Lung Center, 201 Abraham Flexner Way, Suite 800, Louisville, KY 40202 USA. mpflah01@louisville.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Flaherty
authors.forename: Sameh
authors.initials: S
authors.lastname: Sayfo
authors.forename: Jon
authors.initials: J
authors.lastname: Resar
mesh_terms: D021721:Balloon Occlusion; D006328:Cardiac Catheterization / Q000379:methods*; D004417:Dyspnea / Q000209:etiology; D017548:Echocardiography, Transesophageal; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D055989:Septal Occluder Device; D000068677:Sildenafil Citrate / Q000008:administration & dosage / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D000068677:Sildenafil Citrate