Surgical Closure of Atrial Septal Defect with High Pulmonary Vascular Resistance--A Case Report

We have reported a case of successful pericardial patch closure of atrial septal defect with high pulmonary vascular resistance in a 32 years aged male. Diagnosis was confirmed by Doppler Echocardiography, Cardiac catheterization and lung biopsy. Before starting (orally) bosentan pulmonary arterial pressure was 105 mm Hg and pulmonary vascular resistance was 8 wood's unit. Bosentan was started at a dosage of 125 mg per day (62.5 mg twice a day) for 4 months before operation in this case. Just day before operation pulmonary arterial pressure was 87 mm Hg. Bosentan lowered pulmonary arterial pressure and reversed remodeling of pulmonary arteries and allowed surgical correction. During the post operative course, partial pressure of oxygen was significantly decreased and bilateral radiolucent opacity was present in lower zone of both lungs. All these were managed successfully in postoperative period. This case report has demonstrated that surgical correction of an atrial septal defect is feasible but requires long time pre and post operative treatment with pulmonary vasodilators.