Abstract 2130: Long-term Outcomes of Adult Atrial Septal Defect With Severe Pulmonary Hypertension After Surgical Closure

The benefits of surgical closure has been unclear in adult atrial septal defect (ASD) with severe pulmonary hypertension (PHT), and we tried to evaluate improvement of PHT and long-term survival after surgical closure compared to medical follow-up. Methods: From 1996 to 2006, we included a total of 71 adult ASD patients (age; 43±15 years) with severe PHT documented by echocardiography. The inclusion criteria were defined as ASD diameter > 15 mm, enlarged right ventricle, and the baseline peak velocity of tricuspid regurgitation (TR) ≥ 4.0 m/sec. We excluded 5 patients with Eisenmenger syndrome documented by cardiac catheterization. Surgical closure was performed on 55 patients (OP group) and the remaining 16 patients were followed up medically (MED group). The improvement of PHT was defined as TR velocity ≤ 3.5 m/sec on follow-up echo. Results: Baseline characteristics and clinical results were compared between the two groups in table . There were no significant differences in terms of gender, ASD diameter, cardiac rhythm, and TR velocity, but the MED group was significantly older. During follow-up of 46±33 months, there were 5 deaths in the MED group and no operative or late death in the OP group, and the 5-year actuarial survival rate of the OP group was significantly higher than the MED group (58±15%, p<0.05). On subgroup analysis according to age, the OP group showed significantly better survival rates than the MED group (p<0.05) in elderly patients (age > 50). In the OP group, TR velocity was significantly decreased from 4.5±0.4 to 3.0±0.7 m/sec on follow-up echo, and improvement of PHT was observed in 47 (85%) patients. On multivariate analysis, female gender and lower baseline TR velocity were the significant independent predictors of improved PHT after surgery. Conclusions: In adult ASD with severe PHT, surgical closure can be safely performed and improve PHT effectively. Especially in elderly patients, ASD closure is significantly related with the better survival rates.

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Late Surgical Closure of Secundum Type Atrial Septal Defect

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239600400309 ◽

1996 ◽

Vol 4 (3) ◽

pp. 164-167

Author(s):

Binali Mavitaş ◽

S Fehmi Katircioğlu ◽

Birol Yamak ◽

Ahmet Saritaş ◽

Gürkan Uzunonat ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Surgical Closure ◽

Long Term Follow Up

Between 1968 and 1995, a total of 153 patients who were between 35 and 63 years of age (mean 49.8 years), underwent surgery for secundum type atrial septal defect. There were 78 (50.9%) males and 75 females (49.1 %). Mean left-to-right shunt ratio was calculated as 2.49. Mean pulmonary artery pressure was 50.15 mm Hg. Three patients died within 30 days of surgery, giving a hospital mortality of 1.96%. Long-term follow-up was available in 135 cases (90%). Total follow-up was 967.3 patient-years and ranged from 3 months to 11.3 years (mean 7.16 years). There were no late deaths reported. Four patients were readmitted with atrial fibrillation and 2 with pericardial effusion. In our experience, surgical closure of atrial septal defect in adults was found to be successful, safe, and with low morbidity in patients with pulmonary hypertension and congestive heart failure.

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Surgical Strategy in Patients with Atrial Septal Defect and Severe Pulmonary Hypertension

The Heart Surgery Forum ◽

10.1532/hsf98.20111085 ◽

2012 ◽

Vol 15 (2) ◽

pp. 111 ◽

Cited By ~ 9

Author(s):

Yang Hyun Cho ◽

Tae-Gook Jun ◽

Ji-Hyuk Yang ◽

Pyo Won Park ◽

June Huh ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Tricuspid Regurgitation ◽

Septal Defect ◽

Maze Procedure ◽

Severe Pulmonary Hypertension ◽

Tricuspid Annuloplasty ◽

Pulmonary Arterial ◽

Asd Closure

The aim of the study was to review our experience with atrial septal defect (ASD) closure with a fenestrated patch in patients with severe pulmonary hypertension. Between July 2004 and February 2009, 16 patients with isolated ASD underwent closure with a fenestrated patch. All patients had a secundum type ASD and severe pulmonary hypertension. Patients ranged in age from 6 to 57 years (mean � SD, 34.9 � 13.5 years). The follow-up period was 9 to 59 months (mean, 34.5 � 13.1 months). The ranges of preoperative systolic and pulmonary arterial pressures were 63 to 119 mm Hg (mean, 83.8 � 13.9 mm Hg) and 37 to 77 mm Hg (mean, 51.1 � 10.1 mm Hg). The ranges of preoperative values for the ratio of the pulmonary flow to the systemic flow and for pulmonary arterial resistance were 1.1 to 2.7 (mean, 1.95 � 0.5) and 3.9 to 16.7 Wood units (mean, 9.8 � 2.9 Wood units), respectively. There was no early or late mortality. Tricuspid annuloplasty was performed in 14 patients (87.5%). The peak tricuspid regurgitation gradient and the ratio of the systolic pulmonary artery pressure to the systemic arterial pressure were decreased in all patients. The New York Heart Association class and the grade of tricuspid regurgitation were improved in 13 patients (81.2%) and 15 patients (93.7%), respectively. ASD closure in patients with severe pulmonary hypertension can be performed safely if we create fenestration. Tricuspid annuloplasty and a Cox maze procedure may improve the clinical result. Close observation and follow-up will be needed to validate the long-term benefits.

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Long-term outcome after percutaneous shunt closure of selected patients with atrial septal defect and severe pulmonary hypertension

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2018.10.286 ◽

2019 ◽

Vol 11 (1) ◽

pp. 130

Author(s):

M. Tortigue ◽

M. Humbert ◽

O. Sitbon ◽

G. Simmoneau ◽

X. Jais ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Severe Pulmonary Hypertension ◽

Term Outcome ◽

Long Term Outcome ◽

Shunt Closure

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Atrial Septal Defect With Severe Pulmonary Hypertension in Elderly Patients: Usefulness of Transient Balloon Occlusion

Revista Española de Cardiología (English Edition) ◽

10.1016/s1885-5857(10)70172-9 ◽

2010 ◽

Vol 63 (7) ◽

pp. 860-864

Author(s):

Ángel Sánchez-Recalde ◽

José M. Oliver ◽

Guillermo Galeote ◽

Ana González ◽

Luis Calvo ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Elderly Patients ◽

Atrial Septal Defect ◽

Septal Defect ◽

Balloon Occlusion ◽

Severe Pulmonary Hypertension

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Surgical repair of atrial septal defect with severe pulmonary hypertension during pregnancy: a case report with literature review

Cardiology in the Young ◽

10.1017/s1047951112000492 ◽

2012 ◽

Vol 22 (5) ◽

pp. 493-498 ◽

Cited By ~ 2

Author(s):

Suganya Manivannan ◽

Gul Dadlani ◽

Michael Parsons ◽

Luminita Crisan ◽

Victoria Belogolovkin ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Surgical Repair ◽

Severe Pulmonary Hypertension ◽

Secundum Atrial Septal Defect ◽

Viable Option ◽

Surgical Closure ◽

Septal Defects ◽

Pulmonary Arterial

AbstractWe are reporting a case of a 37-year-old pregnant woman with a large secundum atrial septal defect with left-to-right shunt and severe pulmonary hypertension. Her atrial septal defect was undiagnosed before this pregnancy. After carefully considering all the options, we repaired her atrial septal defect with an open heart surgical closure at 20 weeks of gestation. A substantial and consistent reduction in pulmonary arterial pressure after the surgery and subsequent uneventful delivery indicate that surgical repair of atrial septal defects is a viable option that should be considered for such patients.

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