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Original research
Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension
  1. Yoichi Takaya1,
  2. Teiji Akagi1,
  3. Ichiro Sakamoto2,
  4. Hideaki Kanazawa3,
  5. Gaku Nakazawa4,
  6. Tsutomu Murakami5,
  7. Atsushi Yao6,
  8. Mamoru Nanasato7,
  9. Mike Saji7,
  10. Mitsugu Hirokami8,
  11. Yasushi Fuku9,
  12. Shinobu Hosokawa10,
  13. Norio Tada11,
  14. Kensuke Matsumoto12,
  15. Masao Imai13,
  16. Koji Nakagawa1,
  17. Hiroshi Ito1
  1. 1Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
  2. 2Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
  3. 3Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
  4. 4Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
  5. 5Department of Cardiology, Tokai University Hospital, Isehara, Japan
  6. 6Division for Health Service Promotion, University of Tokyo, Tokyo, Japan
  7. 7Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
  8. 8Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
  9. 9Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
  10. 10Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan
  11. 11Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
  12. 12Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
  13. 13Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
  1. Correspondence to Dr Yoichi Takaya, Department of Cardiovascular Medicine, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; takayayoichi{at}


Objective Therapeutic strategies for atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) are controversial. This study aimed to evaluate the efficacy of PAH-specific medications and subsequent transcatheter closure (ie, treat-and-repair strategy) on clinical outcomes.

Methods We enrolled 42 patients who were referred to 13 institutions for consideration of ASD closure with concomitant PAH and underwent the treat-and-repair strategy. The endpoint was cardiovascular death or hospitalisation due to heart failure or exacerbated PAH.

Results At baseline prior to PAH-specific medications, pulmonary to systemic blood flow ratio (Qp:Qs), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (PAP) were 1.9±0.8, 6.9±3.2 Wood units and 45±15 mm Hg. Qp:Qs was increased to 2.4±1.2, and PVR and mean PAP were decreased to 4.0±1.5 Wood units and 35±9 mm Hg at the time of transcatheter ASD closure after PAH-specific medications. Transcatheter ASD closure was performed without any complications. During a median follow-up period of 33 months (1–126 months) after transcatheter ASD closure, one older patient died and one patient was hospitalised due to heart failure, but the other patients survived with an improvement in WHO functional class. PAP was further decreased after transcatheter ASD closure.

Conclusions The treat-and-repair strategy results in low complication and mortality rates with a reduction in PAP in selected patients with ASD complicated with PAH who have a favourable response of medical therapy.

  • atrial septal defect
  • pulmonary arterial hypertension

Data availability statement

This study is based on data from our institutions. The data are available from the corresponding author on reasonable request.

Statistics from

Data availability statement

This study is based on data from our institutions. The data are available from the corresponding author on reasonable request.

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  • Contributors All authors contributed to the collection of data, discussion and interpretation of the data, and the writing of the report. All authors reviewed and approved the manuscript for submission. The study was designed by YT, TA, KN and HI. The analysis was performed by YT. The manuscript was written by YT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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