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Updated: Jul 12, 2026

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Pulmonary Arterial Hypertension With a Secundum Atrial Septal Defect: "Treat-and-Repair" Strategy
Hanna Haile1, Kabir Malkani1, Mohan Satish1
1Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA.
Background:
Pulmonary arterial hypertension (PAH) and congenital heart disease (CHD), particularly in pretricuspid shunts or Eisenmenger syndrome, are associated with significant mortality and limited therapeutic options.
Case Summary:
A 35-year-old woman presented with hypoxemia and right heart strain at 12 weeks' gestation. Echocardiography and right heart catheterization revealed severe PAH and a large secundum atrial septal defect (ASD). Following pregnancy termination and gradual initiation of triple pulmonary vasodilator therapy, her PAH improved significantly over 8 years. She underwent fenestrated ASD closure with significant improvement in functional status.
Discussion:
This case illustrates a "treat-and-repair" strategy in PAH in CHD (PAH-CHD) and highlights how medical therapy can convert a previously inoperable patient into a procedural candidate.
Take-Home Messages:
Combined pulmonary vasodilator therapy can improve PAH and make ASD closure in PAH-CHD feasible. A "treat-and-repair" strategy requires multidisciplinary care.
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