TY - JOUR
T1 - Treat and repair strategy in patients with atrial septal defect and significant pulmonary arterial hypertension
AU - Kijima, Yasufumi
AU - Akagi, Teiji
AU - Takaya, Yoichi
AU - Akagi, Satoshi
AU - Nakagawa, Koji
AU - Kusano, Kengo
AU - Sano, Shunji
AU - Ito, Hiroshi
N1 - Funding Information:
The authors thank the following physicians for treating the patients with severe PAH: Hiromi Matsubara from Okayama Medical Center, Yu Taniguchi and Toshiro Shinke from Kobe University Graduate School of Medicine, Ichiro Sakamoto and Tomotake Tokuno from Kyushu University Hospital, Yukio Kazatani from Ehime Prefectural Central Hospital, Isao Aburadani from Toyama Prefectural Central Hospital, and Toshihiro Sarashina and Kazufumi Nakamura from Okayama University Hospital. The authors also thank Manabu Taniguchi and Hiroki Oe for supporting our study as specialists of echocardiography, and Madoka Ikeda for collecting the echocardiographic data.
Publisher Copyright:
© 2016, Japanese Circulation Society. All rights reserved.
PY - 2015/12/25
Y1 - 2015/12/25
N2 - Background: A therapeutic strategy in patients with atrial septal defect (ASD) and significant pulmonary arterial hypertension (PAH) remains controversial. This study aimed to assess the effect of PAH-specific medications and subsequent transcatheter shunt closure (ie, a treat and repair strategy) in these patients. Methods and Results: Among 646 patients with ASD, 22 patients (mean age of 56±20 years) who had PAH [mean pulmonary artery pressure ≥25 mmHg and pulmonary vascular resistance (PVR) ≥3 Wood units] underwent successful transcatheter ASD closure. Prior to the procedure, 8 patients received PAH-specific medications (PHM group) and 14 patients did not (non-PHM group). Initially, the PHM group had higher PVR compared with non-PHM group (9.6±3.8 vs. 4.2±1.0 Wood units, P<0.01). After treatment with PAH-specific medications, PVR in this group decreased to 4.0±0.8 Wood units (P<0.01). No adverse events were observed in either the PHM or non-PHM group during or after the transcatheter procedure. In the PHM group, during a treatment period of 52±48 months, the World Health Organization Functional Classification significantly improved (3.0±0.5 to 2.0±0.0, P<0.01), as well as in the non-PHM group (2.1±0.6 to 1.5±0.5, P<0.01). Conclusions: Treat and repair strategy provided substantial improvement and no worsening of the WHO-FC, even in patients with ASD and significant PAH. Long-term hemodynamic follow-up is mandatory to evaluate the ultimate efficacy and safety of this new strategy.
AB - Background: A therapeutic strategy in patients with atrial septal defect (ASD) and significant pulmonary arterial hypertension (PAH) remains controversial. This study aimed to assess the effect of PAH-specific medications and subsequent transcatheter shunt closure (ie, a treat and repair strategy) in these patients. Methods and Results: Among 646 patients with ASD, 22 patients (mean age of 56±20 years) who had PAH [mean pulmonary artery pressure ≥25 mmHg and pulmonary vascular resistance (PVR) ≥3 Wood units] underwent successful transcatheter ASD closure. Prior to the procedure, 8 patients received PAH-specific medications (PHM group) and 14 patients did not (non-PHM group). Initially, the PHM group had higher PVR compared with non-PHM group (9.6±3.8 vs. 4.2±1.0 Wood units, P<0.01). After treatment with PAH-specific medications, PVR in this group decreased to 4.0±0.8 Wood units (P<0.01). No adverse events were observed in either the PHM or non-PHM group during or after the transcatheter procedure. In the PHM group, during a treatment period of 52±48 months, the World Health Organization Functional Classification significantly improved (3.0±0.5 to 2.0±0.0, P<0.01), as well as in the non-PHM group (2.1±0.6 to 1.5±0.5, P<0.01). Conclusions: Treat and repair strategy provided substantial improvement and no worsening of the WHO-FC, even in patients with ASD and significant PAH. Long-term hemodynamic follow-up is mandatory to evaluate the ultimate efficacy and safety of this new strategy.
KW - Atrial septal defect
KW - Catheter intervention
KW - Pulmonary hypertension
KW - Treat and repair strategy
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U2 - 10.1253/circj.CJ-15-0599
DO - 10.1253/circj.CJ-15-0599
M3 - Article
C2 - 26567484
AN - SCOPUS:84951771317
VL - 80
SP - 227
EP - 234
JO - Circulation Journal
JF - Circulation Journal
SN - 1346-9843
IS - 1
ER -