Pulmonary Hypertension Outcomes After Closure of Atrial Septal Defect in Infants With Developmental Lung Disease

Pulmonary hypertension (PHTN) in infants with developmental lung disease, such as bronchopulmonary dysplasia (BPD), chronic lung disease of infancy (CLD), or congenital diaphragmatic hernia (CDH), can be exacerbated by atrial septal shunts secondary to atrial septal defects (ASD). While transcatheter ASD closure may reduce pulmonary overcirculation, data on post-closure hemodynamic and pharmacologic outcomes remain limited. This single-center retrospective study aimed to characterize changes in PHTN severity, respiratory support, and medication use 1 year after early transcatheter ASD closure (defined as closure at ≤ 1 year of age). Eligible patients were infants with BPD, CLD, or CDH who underwent early transcatheter ASD closure between 2021 and 2024 and had preprocedural PHTN medication use and respiratory support. Sixteen infants met the inclusion criteria. At 1 year, excluding the 3 who died, 10 of 13 infants (76.9%) showed improved PHTN severity, including 6 (60%) with complete resolution. Of the 13 infants, 6 (46.2%) weaned off all respiratory support. Average diuretic dosage (mg/kg/day) decreased by 92.9%, and vasodilator dosage declined by 47.0%. Infants with ASDs ≥ 5 mm and gestational age (GA) < 32 weeks required significantly longer diuretic therapy than those with smaller ASDs (< 5 mm) and GA ≥ 32 weeks. No similar associations were found with vasodilator weaning. These findings suggest early transcatheter ASD closure may offer therapeutic benefit in select high-risk infants, resulting in improved hemodynamics and reduced medication dependence. Although limited by small sample size and retrospective design, this study supports the potential for individualized weaning strategies and the need for prospective multicenter investigations.