Abstract

OBJECTIVES To examine the outcomes in patients with moderate or severe pulmonary arterial hypertension (PAH) undergoing percutaneous atrial septal defect (ASD) closure.

DESIGN Retrospective study.

SETTING Teahcing hospital based study.

PATIENTS Fifty-four patients with moderate (n= 34) or severe PAH (n=20) underwent successful device implantation between 1999-2004 and were included in the study. Clinical and transthoracic echocardiographic data was reviewed. Pulmonary hypertension was classified as moderate (50-59 mmHg) or severe (≥ 60 mmHg) according with the right ventricular systolic pressure (RVSP) calculated by echocardiography.

RESULTS At the early follow-up (mean 2.3 ± 1.2 months) all patients were alive and the baseline RVSP decreased from 57 ¡À 11 mmHg to 51 ± 17 mmHg (p=0.003). At the late follow-up (n=39, mean duration 31 ± 15 months) two patients died and the baseline RVSP decreased from 58 ± 10 mmHg to 44 ± 16 mmHg (p<0.001). Although the overall mean RVSP decreased at late follow-up, only 43% (17/39) of patients had normalization (<40mmHg) of the RVSP and 15% (6/39) had persistent severe PAH.

CONCLUSION Transcatheter closure in patients with secundum ASD and PAH can be successfully performed in selected individuals and is associated with good outcomes. Early improvements in RVSP are seen in patients with moderate or severe PAH undergoing transcatheter ASD closure. Continued improvement in RVSP occurs in late follow-up. Despite decreases in the mean RVSP in late follow-up, many patients do not have complete normalization of pressures.