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Pulmonary Hypertension and Atrial Septal Defect: Management Dilemma.
Karim El-Kersh1, Molly Howsare, Ali Zaidi
11Department of Medicine, Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, KY; 2Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and 3Department of Medicine, Division of Cardiology, University of Louisville, Louisville, KY.
American Journal of Therapeutics
|August 31, 2016
Summary
Managing atrial septal defects (ASD) with pulmonary hypertension requires expert evaluation, especially before considering defect closure. Incorrect closure in certain patients can lead to adverse outcomes.
Area of Science:
- Cardiology
- Pulmonary Hypertension
- Congenital Heart Disease
Background:
- Atrial septal defect (ASD) management in patients with pulmonary hypertension (PH) presents complex clinical decisions.
- The advent of pulmonary arterial vasodilator therapy has altered the landscape of PH treatment.
- Evaluating the suitability of defect closure in ASD patients with PH is critical.
Observation:
- Patients with ASD and PH require specialized assessment by pulmonary hypertension experts.
- The decision-making process for ASD closure is intricate and multifactorial.
- Pulmonary arterial vasodilator therapy necessitates a re-evaluation of traditional treatment paradigms.
Findings:
- Defect closure in the 'inappropriate group' of ASD patients with PH is associated with poor outcomes.
- Expert consultation is crucial for identifying patients who would benefit from or be harmed by ASD closure.
- The efficacy of vasodilator therapy influences the risk-benefit analysis of ASD closure.
Implications:
- This underscores the need for multidisciplinary heart teams in managing complex congenital heart disease.
- Timely and accurate expert evaluation can prevent iatrogenic complications and improve patient prognosis.
- Further research is warranted to refine criteria for ASD closure in the setting of PH and vasodilator therapy.
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