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Zhou Z, Gu Y, Tian L, Zheng H, Li S. Development and Validation of a Nomogram of Persistent Pulmonary Hypertension in Adult Pretricuspid Shunts After Correction. J Am Heart Assoc 2024; 13:e032412. [PMID: 38639332 PMCID: PMC11179888 DOI: 10.1161/jaha.123.032412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/05/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Pretricuspid shunts have been associated with poorer survival rates in patients with Eisenmenger syndrome compared with postricuspid shunts and complex lesions. However, the risk stratification for persistent pulmonary hypertension (PH) in this population remains uncertain. METHODS AND RESULTS We retrospectively enrolled 103 patients with pretricuspid shunts with high total pulmonary resistance >4.5 Wood units (estimated pulmonary vascular resistance ≥3 Wood units). During a mean±SD follow-up of 20.95±24.84 months, 32 patients developed postoperative persistent PH after shunt correction. We identified 3 significant predictors of postoperative persistent PH, including mean pulmonary artery pressure after inhaled oxygen ≥40.5 mm Hg (odds ratio [OR], 7.78 [95% CI, 2.02-30.03]; P<0.01), total pulmonary resistance after inhaled oxygen ≥6.5 Wood units (estimated pulmonary vascular resistance ≥5 Wood units; OR, 12.23 [95% CI, 2.12-70.46]; P<0.01), and artery oxygen saturation at rest <95% (OR, 3.34 [95% CI, 1.07-10.44]; P=0.04). We established the prediction model with the C-statistics of 0.85 (95% CI, 0.77-0.93; P<0.01), and the C-statistic was 0.83 (95% CI, 0.80-0.86) after bootstrapping 10 000 times with a good performance of the nomogram calibration curve for predicting persistent PH. CONCLUSIONS Our study presents a multivariable risk stratification model for persistent PH after shunt correction in adults with pretricuspid shunts. This model, based on 3 hemodynamic predictors after inhaled oxygen, may assist in identifying individuals at higher risk of persistent PH after shunt correction.
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Affiliation(s)
- Zeming Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
- Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Yuanrui Gu
- Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Lili Tian
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical College Beijing China
| | - Hong Zheng
- Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
| | - Shiguo Li
- Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China
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2
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Kusner J, Krasuski RA. Pulmonary Hypertension in Adult Congenital Heart Disease-Related Heart Failure. Heart Fail Clin 2024; 20:209-221. [PMID: 38462325 DOI: 10.1016/j.hfc.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Already a challenging condition to define, adult congenital heart disease (ACHD) -associated heart failure (HF) often incorporates specific anatomies, including intracardiac and extracardiac shunts, which require rigorous diagnostic characterization and heighten the importance of clinicians proactively considering overall hemodynamic impacts of using specific therapies. The presence of elevated pulmonary vascular resistance dramatically increases the complexity of managing patients with ACHD-HF. Total circulatory management in patients with ACHD-HF requires input from multidisciplinary care teams and thoughtful and careful utilization of medical, interventional, and surgical approaches.
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Affiliation(s)
- Jonathan Kusner
- Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27705, USA
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Medical Center, Box 3012, Durham, NC 27710, USA.
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3
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Kauling RM, Pelosi C, Cuypers JAAE, van den Bosch AE, Hirsch A, Carvalho JG, Bowen DJ, Kardys I, Bogers AJJC, Helbing WA, Roos-Hesselink JW. Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery. Int J Cardiol 2024; 397:131616. [PMID: 38030038 DOI: 10.1016/j.ijcard.2023.131616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To describe the clinical outcome and quality of life up to 50 years after surgical atrial septal defect (ASD) closure at young age. Primary outcome is defined as MACE (all-cause mortality, cardiac re-interventions, ischemic stroke, endocarditis, heart failure and symptomatic arrhythmia). METHODS Single-center, longitudinal cohort-study evaluating 135 consecutive patients who underwent ASD-closure before the age of 15 years between 1968 and 1980. Participants were invited for extensive cardiac evaluation and assessment of quality-of-life every 10 years. RESULTS Eighty patients (86%) of 93 eligible survivors were included in this study (mean age 52 ± 5 years (range 41-63), 40% male). Median follow-up since surgery was 45 years (range 40-51). Cumulative survival after 50 years was 86% and comparable to the normal Dutch population. Cumulative event-free survival after 45 and 50-years was 59% and 46% respectively (re-intervention in 6, symptomatic arrhythmia in 25, and pacemaker implantation in 10 patients). Right ventricular ejection fraction on CMR was diminished in 6%. Exercise capacity was normal in 77%. There was no pulmonary hypertension. NT-proBNP was elevated in 61%. Quality of life was comparable with the general population. No predictors for late events were identified. CONCLUSION Long-term survival after surgical ASD-closure in childhood is good and not statistically different at 50 years compared to the normal Dutch population. Re-intervention rate is low, there is no pulmonary hypertension. Right ventricular function was diminished in 6%, exercise capacity was good and stable over time with quality of life comparable to the general population. However, supraventricular tachycardia is common.
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Affiliation(s)
- Robert M Kauling
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands.
| | - Chiara Pelosi
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - João G Carvalho
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Daniel J Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Isabella Kardys
- Clinical Epidemiology and Innovation Unit, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wim A Helbing
- Department of Pediatrics, division of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
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4
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Liu Y, Wang H, Lan L, Shao J. A commentary regarding the article 'A meta-analysis of atrial septal defect closure in patients with severe pulmonary hypertension: Is there a room for poking holes amidst debate?'. Curr Probl Cardiol 2024; 49:102188. [PMID: 37952793 DOI: 10.1016/j.cpcardiol.2023.102188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
Atrial septal defects (ASD) are a common congenital heart defect. The majority of patient with ASDs often follow an uncomplicated course of events. However, a proportion of patients with ASDs, may have their condition complicated by pulmonary hypertension (PH), with a subsequent significant impact on management, morbidity, and mortality. The presence of PH influences the suitability for defect closure. Suitability for ASD closure when PVR is between 2.3 and 4.6 WU (PVRi 4-8 WU/m2) is not straightforward and clinical decision-making is individualized. Considerations include, whether to intervene with a complete defect closure, fenestrated closure or the 'treat and repair' strategy. However, it is difficult to determine the outcomes for ASD closure in patients with moderately-to-severely elevated PVR. A "treat and repair strategy" might be an option. In addition, the patient should be carefully selected by the observation of PVR change through vasoreactivity and balloon occlusion tests, and then closure should be considered. For patients with a predictable poor prognosis, research on the risk assessment of ASD closure in patients with PAH will be needed for a more individualized treatment plan.
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Affiliation(s)
- Yongqi Liu
- Department of Respiratory and Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
| | - Hong Wang
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China.
| | - Lin Lan
- Department of Neurology, West China Hospital of Sichuan University, Sichuan, Chengdu 610041, China
| | - Jie Shao
- Department of Emergency, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
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5
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Sandeep B, Li H, Huang X, Xiao Z. An editorial regarding the article 'A meta-analysis of atrial septal defect closure in patients with severe pulmonary hypertension: is there a room for poking holes amidst debate?'. Curr Probl Cardiol 2024; 49:102172. [PMID: 37907187 DOI: 10.1016/j.cpcardiol.2023.102172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/28/2023] [Indexed: 11/02/2023]
Abstract
Pulmonary arterial hypertension (PAH) related to an atrial septal defect (ASD) poses a challenge to transcatheter closure of an ASD. In patients with untreated ASDs, chronic pulmonary over-circulation due to shunt flow can cause pulmonary vascular remodeling and increased pulmonary vascular resistance. PAH is one of the difficult situations to treat. Complex pathophysiology, association of the multiple comorbidities make clinical scenario challenging. The closure of ASD in patients with PAH improves PAH severity and cardiac functional capacity and reduces atrial arrhythmias. However, some patients show remaining PAH or aggravation of PAH post-ASD closure. PAH is a strong predictor of mortality in older patients who undergo ASD closure. Hence, the decision to opt for ASD closure should be carefully considered in high-risk patients with PAH. As per the American Heart Association/American College of Cardiology 2018 guidelines, ASD with elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) more than two-thirds systemic is considered to be a contraindication for closure. However, it is difficult to determine the outcomes for ASD closure in patients with moderately-to-severely elevated PVR. A "treat and repair strategy" might be an option. In addition, the patient should be carefully selected by the observation of PVR change through vasoreactivity and balloon occlusion tests, and then closure should be considered. For patients with a predictable poor prognosis, research on the risk assessment of ASD closure in patients with PAH will be needed for a more individualized treatment plan.
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Affiliation(s)
- Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China.
| | - Hong Li
- Department of Anesthesiology, No. 363 Hospital, Chengdu, Sichuan 610017, China
| | - Xin Huang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu 610041, China
| | - Zongwei Xiao
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
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Seol JH, Jung SY, Lee HB, Kim AY, Kim EH, Min IK, Kim NK, Choi JY. Outcomes in Patients with Pulmonary Arterial Hypertension Underwent Transcatheter Closure of an Atrial Septal Defect. J Clin Med 2023; 12:jcm12072540. [PMID: 37048624 PMCID: PMC10095540 DOI: 10.3390/jcm12072540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) related to an atrial septal defect (ASD) poses a challenge to transcatheter closure of an ASD (tcASD). We aimed to determine the predictors for remaining PAH (rPAH) post-tcASD. This retrospective study was conducted at a single tertiary university hospital. Adult patients with an ASD and PAH were divided into three groups according to pulmonary vascular resistance (PVR). Normalization of pulmonary atrial systolic pressure (PASP) was defined as an estimated right ventricular systolic pressure < 40 mmHg and was determined using transthoracic echocardiography. Among 119 patients, 80% showed PAH normalization post-tcASD. Normalization of PAH post-tcASD was observed in 100%, 56.2%, and 28.6% of patients in mild, moderate, and severe PVR groups, respectively. The patients’ New York Heart Association functional class improved. Multivariate logistic regression analysis showed that age and high PVR were significant risk factors for rPAH. A receiving operator curve analysis showed a PASP cutoff value > 67.5 mmHg to be predictive of rPAH post-tcASD, with an area under the curve value of 0.944 (sensitivity, 0.922; specificity 0.933). Most patients, including moderate-to-severe PAH patients, improved hemodynamically and clinically with tcASD. Since patients with severe PAH are at a risk of rPAH, tcASD should be performed by selecting the patient carefully based on pre-procedure medication, a vasoreactivity test, and a balloon occlusion test.
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Affiliation(s)
- Jae-Hee Seol
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Se-Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Han-Byul Lee
- Division of Pediatrics, Soonchunhyang University College of Medicine, Seoul 04401, Republic of Korea
| | - Ah-Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Eun-Hwa Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - In-Kyung Min
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Nam-Kyun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Correspondence: (N.-K.K.); (J.-Y.C.); Tel.: +82-2-2228-8280 (J.-Y.C.)
| | - Jae-Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Correspondence: (N.-K.K.); (J.-Y.C.); Tel.: +82-2-2228-8280 (J.-Y.C.)
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7
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Karunanithi Z, Andersen MJ, Mellemkjær S, Alstrup M, Waziri F, Clemmensen TS, Hjortdal VE, Poulsen SH. Impaired left and right systolic ventricular capacity in corrected atrial septal defect patients. Int J Cardiovasc Imaging 2022; 38:1221-1231. [PMID: 35129735 PMCID: PMC11142960 DOI: 10.1007/s10554-021-02506-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/24/2021] [Indexed: 12/01/2022]
Abstract
Resting right ventricular (RV) systolic function has in some studies been shown to be impaired after correction of an atrial septal defect (ASD) whereas impairment of left ventricular (LV) systolic function is uncertain. In the present study we examine the LV and RV systolic response to exercise in patients with a previously corrected ASD in order to investigate the myocardial capacity. Thirty-six adult ASD patients with a corrected isolated secundum ASD and eighteen adult age-matched controls underent a semi-supine exercise stress echocardiographic examination. At rest, LV parameters were comparable between groups, and RV global longitudinal strain (RV-GLS) was lower for the ASD group (-18.5%, 95% CI -20.0--17.0%) compared with controls (-24.5%, 95% CI -27.7--22.4%, p < 0.001). At peak exercise, LV ejection fraction (LVEF) was lower for ASD patients (61%, 95% CI 58-65%) compared with controls (68%, 95% CI 64-73% p = 0.01). Peak LV global longitudinal strain (LV-GLS) was borderline significantly lower (ASD: -18.4%, 95% CI -20.2--16.6%, controls: -21.3%, 95% CI -23.6--19.0%, p = 0.059). Both RVEF (ASD: 64%, 95% CI 60-68%, controls: 73%, 95% CI 65-80%, p = 0.05) and tricuspid annular plane systolic excursion (TAPSE) (ASD: 2.5 cm, 95% CI 2.3-2.7 cm, controls: 3.2 cm, 95% CI 2.9-3.6 cm, p < 0.001) at peak exercise were lower for ASD patients. Exercise assessed peak oxygen uptake was comparable between groups (ASD: 32.8 mL O2/kg/min, 95% CI 30.3-35.5 mL O2/kg/min, controls: 35.2 mL O2/kg/min, 95% CI 31.6-38.8 mL O2/kg/min, p = 0.3). Corrected ASD patients demonstrate a reduced LV and RV systolic exercise response decades after ASD correction whereas resting parameters of LV and RV systolic function were within normal range. The presence of subclinical systolic myocardial dysfunction during exercise might be associated with the long-term morbidities documented in this patient group.
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Affiliation(s)
- Zarmiga Karunanithi
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Mads Jønsson Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Søren Mellemkjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mathias Alstrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Farhad Waziri
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Tor Skibsted Clemmensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
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8
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Rubáčková Popelová J, Tomková M, Tomek J, Živná R. Long-Term Survival of Adult Patients With Atrial Septal Defect With Regards to Defect Closure and Pulmonary Hypertension. Front Cardiovasc Med 2022; 9:867012. [PMID: 35571174 PMCID: PMC9095928 DOI: 10.3389/fcvm.2022.867012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background Atrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults and pulmonary hypertension (PH) is an established risk factor. A decision whether to perform ASD closure, especially in elderly patients with PH, is a complex dilemma. The aim of our study was to compare long-term survival in patients with closed and open ASD. Methods A retrospective cohort study was performed on 427 patients with ASD (median age at diagnosis 38 years, IQR 18-56) out of which 186 patients (44%) manifested PH. ASD closure in patients with PH was only considered in patients without Eisenmenger syndrome with pulmonary vascular resistance < 5 WU. Median follow-up duration was 18 years (IQR 9-31 years). Kaplan-Meier and Cox proportional hazards survival analyses were performed to evaluate 12 potential predictors of survival. Results Defect closure was associated with improved long-term survival in ASD patients both with (P < 0.001) and without PH (P = 0.01) and this association was present also in patients over 40 years. The 20-year survival since diagnosis was significantly higher in patients with PH and closed ASD compared to those with PH and open ASD (65% vs. 41%). ASD closure was a significant independent predictor of long-term survival (P = 0.003) after accounting for age at diagnosis, PH, NYHA class, Eisenmenger syndrome, and mitral regurgitation. Significant negative independent predictors of survival were older age at diagnosis (P < 0.001), Eisenmenger syndrome (P < 0.001), and PH (P = 0.03). Conclusion ASD closure appears to be associated with improved long-term survival independently of age, PH, and other clinical variables.
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Affiliation(s)
- Jana Rubáčková Popelová
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czechia.,Faculty Hospital Motol, Pediatric Heart Centre, Prague, Czechia
| | - Markéta Tomková
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czechia.,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jakub Tomek
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czechia.,Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Renata Živná
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czechia
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9
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Sahebjam M, Toofaninejad N, Ajam A, Hosseini K, Jalali A, Zoroufian A. Assessment of Left Ventricular Function and Mitral Regurgitation Severity Early After Percutaneous Device Closure of the Atrial Septal Defect. Crit Pathw Cardiol 2022; 21:30-35. [PMID: 34907937 DOI: 10.1097/hpc.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial septal defect (ASD) is one the most prevalent forms of congenital heart disease in adults. Closure of ASDs eliminates left-to-right shunt and reduces right heart volumes, but the effects of ASD closure, on the left ventricle (LV) and mitral valve competence are somewhat inconsistent. Therefore, we designed this study to evaluate the early effect of percutaneous closure of ASD on LV function and mitral regurgitation (MR) severity. METHODS In this prospective study, we enrolled 32 patients with ASD secundum who underwent percutaneous device closure in Tehran Heart Center. We used transthoracic and transesophageal echocardiography (TEE) before the procedure and TTE 24 hours after the procedure, then compared obtained LV parameters before and after the procedure. RESULTS LV end-diastolic diameter (LVEDD) increased significantly from 44.8 ± 2.4 to 45.8 ± 2.8 (P < 0.001). LV end-systolic diameter (LVESD) also increased but was statistically insignificant (P = 0.063) and LV ejection fraction (LVEF) remained nearly unchanged. Highest alteration was in right ventricular systolic pressure (12.4% decrease; P < 0.001) and mitral early Doppler/tissue Doppler velocity ratio (E/E') (9.7% increase; P = 0.010). The change in MR severity was insignificant using Wilcoxon signed-rank test (P = 0.157). CONCLUSIONS We concluded that systolic functions do not change immediately. However, LVEDD and E/E' will increase immediately, resulting from the passage of all blood from the LA into the LV in the early diastole just after closure. We also observed the positive effect of device closure on reducing right ventricular systolic pressure, and at least it does not worsen MR early after the procedure.
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Affiliation(s)
- Mohammad Sahebjam
- From the Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Toofaninejad
- From the Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ajam
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Zoroufian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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10
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Tanaka S, Imamura T, Narang N, Fukuda N, Ueno H, Kinugawa K. Practical Therapeutic Management of Percutaneous Atrial Septal Defect Closure. Intern Med 2022; 61:15-22. [PMID: 33583888 PMCID: PMC8810241 DOI: 10.2169/internalmedicine.5944-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Atrial septal defects (ASDs) are one of the most common congenital heart disorders encountered by cardiologists. Percutaneous ASD closure for secundum ASD is commonly performed not only for children but also for adults, given its non-inferiority to surgical repair. The choice of closure technique should be based on assessing a patient's baseline comorbidities, including the presence of pulmonary hypertension, supraventricular tachycardias, and left ventricular diastolic dysfunction. Furthermore, anatomical features and defect types determined using echocardiography need to be considered when developing a management plan. Percutaneous closure is often the preferred method, given its comparable successful rate to surgical repair while also being far less invasive.
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Affiliation(s)
- Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Japan
| | | | - Nobuyuki Fukuda
- Second Department of Internal Medicine, University of Toyama, Japan
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama, Japan
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11
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Abstract
Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5% to 10% of adults with CHD and is associated with significant morbidity and mortality. PAH-CHD develops as a consequence of intracardiac or extracardiac systemic-to-pulmonary shunts that lead to pulmonary vascular remodeling through a pathologic process that is similar to other causes of PAH. Eisenmenger syndrome is the most severe phenotype of PAH-CHD and is characterized by severe elevation in pulmonary vascular resistance, with shunt reversal causing hypoxemia and central cyanosis. The primary management strategy for most patients with PAH-CHD is medical therapy, although defect closure is considered in select cases.
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Affiliation(s)
- Sarah A Goldstein
- Section of Adult Congenital Heart Disease, Division of Cardiology, Duke University Medical Center, Box 3331, Durham, NC 27710, USA
| | - Richard A Krasuski
- Section of Adult Congenital Heart Disease, Division of Cardiology, Duke University Medical Center, Box 3331, Durham, NC 27710, USA.
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12
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Karunanithi Z, Andersen MJ, Mellemkjær S, Alstrup M, Waziri F, Skibsted Clemmensen T, Elisabeth Hjortdal V, Hvitfeldt Poulsen S. Elevated Left and Right Atrial Pressures Long-Term After Atrial Septal Defect Correction: An Invasive Exercise Hemodynamic Study. J Am Heart Assoc 2021; 10:e020692. [PMID: 34259012 PMCID: PMC8483478 DOI: 10.1161/jaha.120.020692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite correction of the atrial septal defect (ASD), patients experience atrial fibrillation frequently and have increased morbidity and mortality. We examined physical capacity, cardiac performance, and invasive hemodynamics in patients with corrected ASD. Methods and Results Thirty‐eight corrected patients with isolated secundum ASD and 19 age‐matched healthy controls underwent right heart catheterization at rest and during exercise with simultaneous expired gas assessment and echocardiography. Maximum oxygen uptake was comparable between groups (ASD 32.7±7.7 mL O2/kg per minute, controls 35.2±7.5 mL O2/kg per minute, P=0.3), as was cardiac index at both rest and peak exercise. In contrast, pulmonary artery wedge v wave pressures were increased at rest and peak exercise (rest: ASD 14±4 mm Hg, controls 10±5 mm Hg, P=0.01; peak: ASD 25±9 mm Hg, controls 14±9 mm Hg, P=0.0001). The right atrial v wave pressures were increased at rest but not at peak exercise. The transmural filling pressure gradient (TMFP) was higher at peak exercise among patients with ASD (10±6 mm Hg, controls 7±3 mm Hg, P=0.03). One third of patients with ASD demonstrated an abnormal hemodynamic exercise response defined as mean pulmonary artery wedge pressure ≥25 mm Hg and/or mean pulmonary artery pressure ≥35 mm Hg at peak exercise. These patients had significantly elevated peak right and left atrial a wave pressures, right atrial v wave pressures, pulmonary artery wedge v wave pressures, and transmural filling pressure compared with both controls and patients with ASD with a normal exercise response. Conclusions Patients with corrected ASD present with elevated right and in particular left atrial pressures at rest and during exercise despite preserved peak exercise capacity. Abnormal atrial compliance and systolic atrial function could predispose to the increased long‐term risk of atrial fibrillation. Registration Information clinicaltrials.gov. Identifier: NCT03565471.
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Affiliation(s)
- Zarmiga Karunanithi
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | | | - Søren Mellemkjær
- Department of Cardiology Aarhus University Hospital Aarhus N Denmark
| | - Mathias Alstrup
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Farhad Waziri
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark.,Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | | | - Vibeke Elisabeth Hjortdal
- Department of Clinical Medicine Aarhus University Aarhus N Denmark.,Department of Cardiothoracic Surgery, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Clinical Medicine Aarhus University Aarhus N Denmark.,Department of Cardiology Aarhus University Hospital Aarhus N Denmark
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13
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Li X, Li T. Inadequate Dosage May Lead to the Recurrence of Postoperative Pulmonary Hypertension in Patients With Congenital Heart Disease. Front Pharmacol 2021; 12:660405. [PMID: 33995082 PMCID: PMC8117148 DOI: 10.3389/fphar.2021.660405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Pulmonary arterial hypertension (PAH) associated with congenital heart disease (PAH-CHD) occurs predominantly among patients with uncorrected congenital heart disease (CHD). It is an intractable problem to control PAH continuously and stably after an operation. Methods: 1) OPLS-DA combined with S-plot was used to retrospectively analyze the results of preoperative and postoperative PAH and 39 biochemical indicators of 235 patients admitted to Fuwai Yunnan Cardiovascular Hospital from January 2019 to December 2020. 2) Combined with Meta-analysis, the recurrence in postoperative PAH was analyzed in terms of operation factors, doses administered, and age factors. Results: 1) 4 indicators (PAH, RBC, HGB, and CO2) that reflect the prognosis of patients had been found by OPLS-DA combined with S-plot. 2) The recurrence rate of postoperative PAH was 37.02%. The comprehensive therapeutic effect of interventional closure was better than that of surgical operation. PAH was not significantly higher again in patients who received either the instruction dose or the literature dose. Postoperative combination therapy (bosentan and sildenafil) was more effective than bosentan alone. Recovery after treatment was better in infants than in the other four age groups. Conclusion: OPLS-DA combined with S-plot was used for the first time to analyze clinical examination data. In this study, this method proved to be a feasible method for analyzing clinical data We recommend interventional closure as the first choice for patients with PAH-CHD. For postoperative oral therapy, we recommend the combination therapy (bosentan with sildenafil). To prevent the recurrence, the dose should be strictly prescribed according to the instructions, literature, or body surface area converted. Moreover, we recommend treatment at a young age in these patients.
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Affiliation(s)
- Xinmei Li
- Yunnan Provincial Key Laboratory of Pharmacology, Kunming Medical University, Kunming, China.,Department of Pharmacy, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Te Li
- Department of Pharmacy, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
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14
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Abstract
PURPOSE OF REVIEW Pulmonary arterial hypertension (PAH) causes high morbidity and mortality in children. In this review, we discuss advances in diagnosis and treatment of this disorder. RECENT FINDINGS Proceedings published from the 2018 World Symposium updated the definition of pulmonary hypertension to include all adults and children with mean pulmonary artery pressure more than 20 mmHg. Targeted PAH therapy is increasingly used off-label, but in 2017, bosentan became the first Food and Drug Administration-targeted PAH therapy approved for use in children. SUMMARY In recent years, advanced imaging and clinical monitoring have allowed improved risk stratification of pulmonary hypertension patients. New therapies, approved in adults and used off-label in pediatric patients, have led to improved outcomes for affected children.
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15
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Akseer S, Horlick E, Vishwanath V, Hobbes B, Huszti E, Mak S, Lee DS, Abrahamyan L. Prevalence and outcomes of pulmonary hypertension after percutaneous closure of atrial septal defect: a systematic review and meta-analysis. Eur Respir Rev 2020; 29:29/158/200099. [PMID: 33328279 DOI: 10.1183/16000617.0099-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/29/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Atrial septal defect (ASD) is a common form of congenital heart disease. Significant shunts may increase the risk of developing pulmonary hypertension (PH). We aimed to describe current PH definitions, evaluate PH prevalence and the effect of PH on outcomes in patients undergoing percutaneous ASD closure. METHODS EMBASE, MEDLINE and Cochrane databases were systematically searched. Studies reporting PH prevalence or mean systolic pulmonary arterial pressure (sPAP) before and after percutaneous ASD closure in adults were included. We conducted meta-analyses to obtain summary estimates for PH prevalence and mean sPAP. RESULTS 15 articles with a total of 1073 patients met the eligibility criteria. Studies applied variable PH definitions. PH prevalence and mean sPAP levels decreased in all studies after closure. The pooled PH prevalence decreased from 44% (95% CI 29-60%) to 18% (95% CI 8-27%). The overall standardised mean difference in sPAP was 1.12 (95% CI 0.81-1.44) and 1.62 (95% CI 1.00-2.23) in cohort and case-series studies respectively indicating a large decrease. The pooled standard mean difference among the younger and older patients were different, 1.25 (95% CI 0.78-1.71) and 0.91 (95% CI 0.56-1.27), respectively. A high degree of between-study heterogeneity was noted. CONCLUSIONS Both PH prevalence and mean sPAP decrease after ASD closure. Larger, prospective studies with consistent PH definitions using the recommended measurement modality are warranted.
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Affiliation(s)
- Selai Akseer
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, ON, Canada
| | - Varnita Vishwanath
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, ON, Canada
| | - Benjamin Hobbes
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, ON, Canada
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Susanna Mak
- Division of Cardiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Douglas S Lee
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada .,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
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16
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Abstract
Pulmonary hypertension (PH), the syndrome of increased pressure in the pulmonary arteries, is associated with significant morbidity and mortality for affected children and is associated with a variety of potential underlying causes. Several pulmonary arterial hypertension-targeted therapies have become available to reduce pulmonary artery pressure and improve outcome, but there is still no cure for most patients. This review provides a description of select causes of PH encountered in pediatrics and an update on the most recent data pertaining to evaluation and management of children with PH. Available evidence for specific classes of PH-targeted therapies in pediatrics is discussed.
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Affiliation(s)
- Benjamin S Frank
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - D Dunbar Ivy
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
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17
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Atrial Septal Defect Closure in Patients With Pulmonary Hypertension. JACC Cardiovasc Interv 2020; 13:2035-2037. [DOI: 10.1016/j.jcin.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 01/31/2023]
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18
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Malik J, Ikram U, Kamal A, Khalid A, Zahid T. Secundum Atrial Septal Defect With Early Presentation of Eisenmenger Syndrome and Right-Heart Failure: A Rare Case Report and Literature Review. Cureus 2020; 12:e8980. [PMID: 32775062 PMCID: PMC7402440 DOI: 10.7759/cureus.8980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Eisenmenger syndrome, the most advanced form of pulmonary arterial hypertension (PAH), poses a considerable risk to the survival and quality of life of patients. It is more commonly seen in large intra-cardiac defects like ventricular septal defects (VSD) or patent ductus arteriosus (PDA), and rarely in atrial septal defects (ASD). Early diagnosis is the single most important step in the definitive management of the condition; otherwise, only conservative treatment can be offered. In this report, we present the case of a 20-year-old female patient diagnosed with Eisenmenger syndrome secondary to a large secundum ASD. The patient responded well to medical treatment.
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19
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Ting CT, Chen JW, Chang MS, Yin FC. Pulmonary hemodynamics and wave reflections in adults with atrial septal defects. Am J Physiol Heart Circ Physiol 2020; 318:H925-H936. [DOI: 10.1152/ajpheart.00534.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Using high-fidelity micromanometers and flow velocity sensors at right heart catheterization, we compared pulmonary hemodynamics and wave reflections in age-matched normal adults and those with atrial septal defects, separated into three subgroups based on levels of mean pulmonary artery pressure: low (<17 mmHg), intermediate (17–26 mmHg), high (>26 mmHg). We made baseline measurements in all groups and after intravenous sodium nitroprusside in the subgroups. All of the subgroups had higher than normal baseline pulmonary flows and corresponding power that did not differ among the subgroups. The pulmonary vascular resistance, input resistance, and characteristic impedance in the subgroups did not differ from normal. Aside from the elevated flow and power, the hemodynamics in the low subgroup did not differ from normal. The intermediate subgroup had significantly higher than normal right ventricular and pulmonary artery pressures, wave reflections, and shorter wave reflection time, which all reverted to normal after nitroprusside. The high subgroup had similar changes as the intermediate subgroup. Unlike that subgroup, however, the pressures, wave reflections, and reflection return time did not revert to normal after nitroprusside. Hence, elevated wave reflections, but not resistance or characteristic impedance, are the hallmark of pulmonary hypertension in adults with atrial septal defects. Our results demonstrate that detailed measurements of hemodynamics and assessment of responsiveness to vasodilators provide important information about the pulmonary circulation in atrial septal defect. Coupled with studies after defect closure, those results may be a better foundation than current ones for clinical decisions.
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Affiliation(s)
- Chih-Tai Ting
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jaw-Wen Chen
- Department of Medical Research, Veterans General Hospital, Taipei, Taiwan
- Department of Medicine and Cardiovascular Research Center, National Yang Ming University School of Medicine, Taipei, Taiwan
- Cardiology Division, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
| | - Mau-Song Chang
- Cardiology Division, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
| | - Frank C.P. Yin
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
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21
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Zwijnenburg RD, Baggen VJ, Witsenburg M, Boersma E, Roos-Hesselink JW, van den Bosch AE. Risk Factors for Pulmonary Hypertension in Adults After Atrial Septal Defect Closure. Am J Cardiol 2019; 123:1336-1342. [PMID: 30709596 DOI: 10.1016/j.amjcard.2019.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Atrial septal defect (ASD) closure is performed to prevent pulmonary hypertension (PH), which is associated with poor outcome. This study investigated the prevalence of PH in adults before and after ASD closure and explored associations between patient characteristics and PH after ASD closure. Consecutive adult patients who underwent surgical or percutaneous ASD closure in the Erasmus MC, the Netherlands, were included (2000 to 2014). Echocardiograms before and after ASD closure were retrospectively assessed. Patients were categorized into 3 groups (no PH, possible PH, and PH) based on tricuspid regurgitation velocity (<2.9, 2.9 to 3.4, and ≥3.4 m/s) or mean pulmonary arterial pressure (<20, 20 to 24, and ≥25 mm Hg). Cox regression was performed to identify associations between patient characteristics and PH after ASD closure. Of the 244 eligible patients who underwent ASD closure, 198 (81%) had echocardiograms both before and median 15 (interquartile range 12 to 35) months after ASD closure (median age at closure 45 [interquartile range 30 to 57] years, 75% woman). The prevalence of PH was 13.1% (n = 26) before ASD closure and 5.0% (n = 10) after closure. New York Heart Association III to IV (hazard ratio [HR] 11.07, 95% confidence interval [CI] 3.12 to 39.29, p <0.001), pulmonary disease (HR 10.43, 95% CI 2.12 to 51.21, p = 0.004), cardiac medication use (HR 3.96, 95% CI 1.02 to 15.34, p = 0.047), right ventricular fractional area change (HR 0.87, 95% CI 0.81 to 0.93, p <0.001), and tricuspid annular plane systolic excursion (HR 0.75, 95% CI 0.59 to 0.95, p = 0.018) were significantly associated with PH. In conclusion, adult patients with low pulmonary pressures before ASD closure are not at risk of PH after closure. Nevertheless, PH remained prevalent in approximately 5% of patients. Especially those patients with high New York Heart Association functional class, presence of pulmonary disease, cardiac medication use and impaired RV function at baseline are at risk.
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