Pulmonary hypertension (PH), defined as mean pulmonary arterial pressure ≥25 mm Hg,
may be a complication of a secundum atrial septal defect (ASD). This study sought
to evaluate the impact of PH at time of ASD device closure on patient survival. A
prospectively collected database of ASD closures was utilized. Patients were stratified
by age above and below the cohort median (48 years). Survival was analyzed by preprocedural
PH status, age cohort, and echocardiographic resolution of PH at 3 months postdevice
closure. PH was present in 48 of 228 patients (21.1%) and was more common in the older
cohort (31.3% vs 10.6%, p <0.01). ASD size was unrelated to the presence of PH (p = 0.33).
Older patients had more medical co-morbidities including diabetes (p = 0.02), hyperlipidemia
(p <0.01), and systemic hypertension (p <0.01) compared with younger patients. PH
did not impact survival in patients ≤48 years, but PH was associated with fivefold
increased risk of death in patients >48 years (p < 0.01). Patients with preprocedural
PH and RVSP ≥40 mm Hg at 3-month follow-up continued to have an increased risk of
mortality (p <0.01), whereas those with resolution of PH had similar survival to those
without PH at time of closure. In conclusion, PH is common in adults with unrepaired
ASDs and appears unrelated to defect size. PH in older adults and its persistence
closure are strong predictors of a worsened clinical outcome. These patients may benefit
from additional risk assessment and advanced medical therapies to mitigate this risk.
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Article info
Publication history
Published online: August 07, 2019
Received in revised form:
July 16,
2019
Received:
May 8,
2019
Footnotes
Funding: This project was partially supported by the Stead Grant from Duke University Internal Medicine Residency Program.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
