PMID- 30346095
OWN - NLM
STAT- MEDLINE
DCOM- 20200210
LR  - 20200210
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 93
IP  - 2
DP  - 2019 Feb 1
TI  - Device closure of atrial septal defect with severe pulmonary hypertension in 
      adults: Patient selection with early and intermediate term results.
PG  - 309-315
LID - 10.1002/ccd.27853 [doi]
AB  - OBJECTIVE: To describe a subset of atrial septal defect (ASD) with severe 
      pulmonary hypertension (PHT) that is suitable for closure. BACKGROUND: As per 
      American Heart Association/American College of Cardiology guidelines, ASD with 
      elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) 
      >2/3rd systemic is considered as a contraindication for closure. METHODS: 
      Patients with anatomically large ASD measuring >25 mm and a high probability of 
      reversible pulmonary vascular disease were subjected to fenestrated device 
      closure, despite severe PHT and elevated PVR. They were discharged on pulmonary 
      vasodilators and were followed for 39.5 +/- 8.5 months. Four patients had repeat 
      cardiac catheterization. RESULTS: Six patients underwent successful device 
      closure of large ASD with severe PHT. Their basal Qp:Qs was 2.8 +/- 0.3:1 while the 
      systolic PAP and the PVR index (PVRI) were 102.6 +/- 11.5 mm Hg and 9.6 +/- 1.6 
      Wu m(2) , respectively. Post 100% oxygen inhalation, the Qp:Qs increased to 3.5 +/- 
      0.3:1, systolic PAP remained 103.5 +/- 7.6 mm Hg while the PVRI dropped to 5.4 +/- 
      1.1 Wu m(2) . The postballoon occlusion systolic PAP decreased to 86.6 +/- 8.8 mm 
      Hg. At the last follow-up, their pulmonary artery systolic pressure by tricuspid 
      regurgitation (TR) jet decreased from 105.6 +/- 12.6 mm Hg to 45 +/- 7.0 mm Hg. 
      During follow-up cardiac catheterization (n = 4), the systolic PAP and PVRI were 
      55.7 +/- 9.2 mm Hg and 3.2 +/- 0.4, respectively. CONCLUSIONS: Patients with 
      anatomically big defect and a large left to right shunt at baseline with a high 
      probability of reversible PVR benefit with ASD closure and pulmonary 
      vasodilators, despite significantly elevated PAP and PVRI.
CI  - (c) 2018 Wiley Periodicals, Inc.
FAU - Dalvi, Bharat
AU  - Dalvi B
AD  - Glenmark Cardiac Centre, Mumbai, India.
FAU - Jain, Shreepal
AU  - Jain S
AUID- ORCID: 0000-0002-2802-2741
AD  - Reliance Foundation Hospital, Mumbai, India.
FAU - Pinto, Robin
AU  - Pinto R
AD  - Holy Family Hospital, Mumbai, India.
LA  - eng
PT  - Journal Article
DEP - 20181022
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Vasodilator Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Antihypertensive Agents/therapeutic use
MH  - *Arterial Pressure/drug effects
MH  - Cardiac Catheterization/adverse effects/*instrumentation
MH  - Female
MH  - Heart Septal Defects, Atrial/diagnostic imaging/physiopathology/*therapy
MH  - Humans
MH  - Male
MH  - *Patient Selection
MH  - Prosthesis Design
MH  - Pulmonary Arterial Hypertension/diagnosis/*physiopathology
MH  - Pulmonary Artery/drug effects/*physiopathology
MH  - Retreatment
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Septal Occluder Device
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Resistance
MH  - Vasodilator Agents/therapeutic use
MH  - Young Adult
OTO - NOTNLM
OT  - ASD/PDA/PFO
OT  - adults
OT  - diagnostic
EDAT- 2018/10/23 06:00
MHDA- 2020/02/11 06:00
CRDT- 2018/10/23 06:00
PHST- 2018/01/30 00:00 [received]
PHST- 2018/07/28 00:00 [revised]
PHST- 2018/08/04 00:00 [accepted]
PHST- 2018/10/23 06:00 [pubmed]
PHST- 2020/02/11 06:00 [medline]
PHST- 2018/10/23 06:00 [entrez]
AID - 10.1002/ccd.27853 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2019 Feb 1;93(2):309-315. doi: 10.1002/ccd.27853. 
      Epub 2018 Oct 22.