Related Experiment Video
Updated: Jun 20, 2026

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Atrial Septal Defect Closure With Persistently Elevated Pulmonary Vascular Resistance
Daniel Inácio Cazeiro1, Rui Plácido2, Sofia Esteves1
1Faculty of Medicine, Department of Cardiology, Unidade Local de Saúde de Santa Maria, CAML, CCUL@RISE, University of Lisbon, Lisbon, Portugal.
Clinical Condition:
A 32-year-old man presented with a secundum atrial septal defect (ASD) complicated by pulmonary arterial hypertension (PAH) with elevated pulmonary vascular resistance (PVR), creating a major operability dilemma.
Key Questions:
What is the diagnostic work-up in suspected pulmonary hypertension? Should genetic testing be performed in congenital heart disease-associated PAH? How should ASD patients with elevated PVR be managed? Should closure be pursued despite persistent PVR elevation? What is the surgical strategy in this setting?
Outcome:
PAH-targeted therapy improved symptoms and reduced PVR, although values remained elevated. After multidisciplinary reassessment, a "treat-to-repair" strategy with fenestrated surgical closure was pursued. Despite transient postoperative right ventricular dysfunction, the patient achieved marked clinical, echocardiographic, biomarker, and hemodynamic recovery.
Take-Home Messages:
Operability in ASD-associated pulmonary hypertension requires individualized, multidisciplinary decision-making beyond fixed PVR cutoffs. Fenestrated ASD closure after targeted PAH therapy can balance shunt reduction and right ventricular protection in patients with elevated PVR.
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