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A case series of pulmonary hypertension in small infants with atrial septal defect
Mohammad Reza Sabri1, Chehreh Mahdavi2, Hamid Bigdelian3
1Professor, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Surgical closure of secundum atrial septal defect (ASD2) in infants with pulmonary hypertension (PH) led to improved PH and normalized heart size. Early intervention is recommended when PH is present without other congenital heart defects.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Pulmonary Hypertension
Background:
- Atrial septal defect (ASD) is a common congenital heart defect (CHD).
- Secundum ASD (ASD2) is the most frequent type, located centrally in the atrial septum.
- Pulmonary hypertension (PH) can be a complication of ASD.
Observation:
- A case series evaluated five infants under one year old with ASD2 and PH.
- All infants were referred for surgical ASD closure.
- The study monitored patients post-surgery for improvements in PH and cardiac dimensions.
Findings:
- Surgical ASD closure resulted in improved PH in all patients.
- Post-surgery, the size of the right atrium (RA) and right ventricle (RV) normalized.
- One year after surgery, pulmonary artery pressure (PAP) and cardiac chamber sizes were normal.
Implications:
- While PH is uncommon in infants with ASD, its presence warrants consideration for ASD closure.
- Early surgical intervention for ASD2 in infants with PH can lead to favorable long-term outcomes.
- This suggests that timely closure of ASD2 may prevent or reverse PH in affected infants.
Background:
Atrial septal defect (ASD) is one of the most common congenital heart defects (CHDs) with prevalence of 8% to 10% in children with CHD and incidence of 56 per 100000 live births. It is categorized according to the defect site in which the most common form is secundum ASD (ASD2) with the defect in the central part of the atrial septum.
Case Report:
In our case series, we evaluated five children aged under one year old with ASD2 and pulmonary hypertension (PH). All the patients were referred for surgical ASD closure. Their PH was improved and the size of right atrium (RA) and right ventricle (RV) became normal during the follow-up and one year after the surgery all of them had normal pulmonary artery pressure (PAP) with normal RA and RV size.
Conclusion:
According to our study and those done by others, the prevalence of PH in infants with ASD is low, but when this combination is found without any other CHD, ASD closure should be considered.
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