Yonsei Med J.  2016 Mar;57(2):306-312. 10.3349/ymj.2016.57.2.306.

Hemodynamic Follow-Up in Adult Patients with Pulmonary Hypertension Associated with Atrial Septal Defect after Partial Closure

• Song J
• Huh J
• Lee SY
• Kang IS
• Lee CH
• Lee C
• Yang JH
• Jun TG

• KMID: 2374033
• DOI: http://doi.org/10.3349/ymj.2016.57.2.306

Abstract

PURPOSE
We evaluated the hemodynamic statuses of patients after partial closure of atrial septal defects with fenestration due to pulmonary hypertension.
MATERIALS AND METHODS
Seventeen adult patients underwent partial atrial septal defect closure and follow-up cardiac catheterization. We analyzed hemodynamic data and clinical parameters before and after closure.
RESULTS
The median age at closure was 29 years old. The baseline Qp/Qs was 1.9+/-0.6. The median interval from the operation to the cardiac catheterization was 27 months. The CT ratio decreased from 0.55+/-0.07 to 0.48+/-0.06 (p<0.05). The mean pulmonary arterial pressure decreased from 50.0+/-11.5 mm Hg to 32.5+/-14.4 mm Hg (p<0.05), and the pulmonary resistance index decreased from 9.2+/-3.6 Wood units*m2 to 6.3+/-3.8 Wood units*m2 (p<0.05). Eleven patients (64.7%) continued to exhibit high pulmonary resistance (over 3.0 Wood units*m2) after closure. These patients had significantly higher pulmonary resistance indices and mean pulmonary arterial pressures based on oxygen testing before the partial closures (p<0.05). However, no significant predictors of post-closure pulmonary hypertension were identified.
CONCLUSION
Despite improvement in symptoms and hemodynamics after partial closure of an atrial septal defect, pulmonary hypertension should be monitored carefully.

Keyword

Atrial septal defect; pulmonary hypertension; partial closure; pulmonary vascular resistance index

MeSH Terms

Adult
Aged
Cardiac Catheterization/*adverse effects
Female
Follow-Up Studies
Heart Defects, Congenital/epidemiology/*physiopathology/*surgery
Heart Septal Defects, Atrial/surgery
Hemodynamics/*physiology
Humans
Hypertension, Pulmonary/diagnosis/epidemiology/*physiopathology
Male
Middle Aged
Oxygen
Postoperative Complications/diagnosis/epidemiology/*physiopathology
Retrospective Studies
Treatment Outcome
Young Adult
Oxygen

Figure

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  Fig. 1 Changes in mPAP (A) and PVRI (B) of each patient. We observed significant decreases from baseline after the oxygen test and after closure. mPAP, mean pulmonary arterial pressure; PVRI, pulmonary vascular resistance index.

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  Fig. 2 Differences in post-closure PVRIs for the patients with mild, moderate, and severe pre-closure PH. PVRI, pulmonary vascular resistance index; PH, pulmonary hypertension.

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  Fig. 3 Significant differences in pre-closure PVRI (A), Qp/Qs (B), and pre-closure mPAP with the oxygen test (C) according to post-closure PVRI (

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  Fig. 4 Various selective pulmonary vasodilators after defect closure.

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