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Pulmonary hypertension in patients with ostium secundum atrial septal defect--is it related to echocardiographic
Rui Providência1, Ana Botelho, Nuno Quintal
1Serviço de Cardiologia, Centro Hospital de Coimbra, Coimbra, Portugal. rui_providencia@yahoo.com
Insights
Pulmonary hypertension (PH) frequently develops in adults with atrial septal defects (ASD), often linked to larger defect size. Early closure of ASDs may prevent PH development, even in those with smaller defects.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Atrial septal defect (ASD) is a common congenital heart defect.
- Pulmonary hypertension (PH) can develop in undiagnosed adult ASD patients.
- The reasons for PH development in some ASD patients remain unclear.
Purpose of the Study:
- To determine the prevalence of PH in ostium secundum ASD (osASD) patients.
- To investigate if echocardiographic defect morphology predicts PH development.
Main Methods:
- 181 adult osASD patients were evaluated for right heart dimensions and ASD morphology.
- Pulmonary artery systolic pressure (PASP) was calculated.
- Shunt type was assessed using agitated saline contrast echocardiography.
Main Results:
- 26.5% of patients had PH (PASP > 40 mmHg).
- PH was more common in older patients and those with larger ASDs (p<0.001).
- PH prevalence was lower in patients with closed ASDs (20.3% vs. 43.75%).
Conclusions:
- PH development in ASD patients is common and associated with defect diameter.
- Smaller, simpler ASDs can also lead to PH, particularly in older individuals.
- Early ASD closure appears to be a preventive measure against PH.
Introduction:
Atrial septal defect (ASD) is one of the most common congenital heart defects. Patients may reach adulthood before being diagnosed and sometimes develop pulmonary hypertension (PH). According to the latest Euro Heart Survey on Congenital Heart Disease, 24.77% of ASD patients develop PH. The reasons for this evolution in only some patients are still unknown.
Objectives:
To assess the prevalence of PH in patients with ostium secundum ASD (osASD) in our district and to determine whether the echocardiographic morphology of the defect can be an indicator of evolution to PH.
Methods:
The study included 181 consecutive patients, mean age 43.1+/-18.4 years, 65.2% women, with a diagnosis of osASD, referred for transthoracic and transesophageal evaluation in our center from January 2000 to September 2008. We assessed right atrial (RA) and ventricular (RV) dimensions, measured the rims and size of the ASD and determined pulmonary artery systolic pressure (PASP) (RV/RA gradient plus a value corresponding to the degree of inferior vena cava collapse). The type of shunt at the atrial level was assessed with intravenous injection of agitated saline. Statistical analysis was performed using SPSS 15.0.
Results:
Seventy-seven patients (42.5%) had moderate to severe enlargement of the right heart chambers and 48 (26.5%) had pulmonary hypertension, defined as PASP of over 40 mmHg (equivalent to mean pulmonary artery pressure of 25-30 mmHg). Patients with PH were older (52.8+/-16.9 vs. 39.0+/-17.6 years; p<0.001) and had larger defects (19.7+/-9.6 mm vs. 13.1+/-7.1 mm; p<0.001). The proportion of women was similar in both groups (64.6% in patients with PH vs. 68.75% in those without; p=NS). Most patients with PH had ASDs with more complex shapes on echocardiography. However, some patients with simpler and smaller defects, such as central ASD with a diameter of <5 mm, also developed PH. The prevalence of PH in patients with closed ASDs was much lower: 20.3% vs. 43.75%; p<0.002.
Conclusions:
According to these data, development of PH in patients with ASD is frequent and seems to be related to the diameter of the defect. However, patients with smaller and simpler defects may also develop PH. This seems to occur at older ages and not to be gender-dependent. Early ASD closure appears to prevent this.
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