TY - JOUR T1 - Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension JF - Heart JO - Heart SP - 382 LP - 387 DO - 10.1136/heartjnl-2021-319096 VL - 108 IS - 5 AU - Yoichi Takaya AU - Teiji Akagi AU - Ichiro Sakamoto AU - Hideaki Kanazawa AU - Gaku Nakazawa AU - Tsutomu Murakami AU - Atsushi Yao AU - Mamoru Nanasato AU - Mike Saji AU - Mitsugu Hirokami AU - Yasushi Fuku AU - Shinobu Hosokawa AU - Norio Tada AU - Kensuke Matsumoto AU - Masao Imai AU - Koji Nakagawa AU - Hiroshi Ito Y1 - 2022/03/01 UR - http://heart.bmj.com/content/108/5/382.abstract N2 - 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.This study is based on data from our institutions. The data are available from the corresponding author on reasonable request. ER -