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Pulmonary hypertension in isolated secundum atrial septal defect: high frequency in young patients
Insights
Pulmonary hypertension affects 17% of patients with atrial septal defects, particularly young individuals. Its high frequency in this group, potentially linked to fetal vascular patterns, remains unexplained.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Pulmonary Hypertension
Background:
- Secundum atrial septal defects (ASD) can lead to pulmonary hypertension.
- The prevalence and characteristics of pulmonary hypertension in young ASD patients require further investigation.
Purpose of the Study:
- To determine the frequency of pulmonary hypertension in patients with isolated secundum atrial septal defects.
- To investigate the occurrence of Eisenmenger reaction in this patient cohort.
- To explore potential causes for pulmonary hypertension in young patients.
Main Methods:
- Retrospective analysis of 709 consecutive patients with isolated secundum atrial septal defects.
- Measurement of pulmonary artery systolic pressure.
- Assessment for Eisenmenger reaction.
- Analysis of patient demographics including age and altitude of residence.
Main Results:
- Pulmonary hypertension was identified in 17% of patients.
- Prevalence was similar across different age groups, including those under 10 and 11-20 years.
- Eisenmenger reaction occurred in 9% of patients, with no significant age-related difference.
- No patients with pulmonary hypertension resided at high altitudes.
Conclusions:
- A significant proportion of patients with secundum ASD develop pulmonary hypertension, with a notable frequency in younger individuals.
- The high incidence of pulmonary hypertension in young patients is not fully understood.
- Persistence of the fetal pulmonary vascular pattern is suggested as a potential contributing factor.
Abstract:
Out of 709 consecutive patients with isolated secundum atrial septal defect, the pulmonary artery systolic pressure was greater than 50 mm Hg in 118 patients (17%). Pulmonary hypertension was present in 13% of patients under 10 years and in 14% aged 11 to 20 years. The Eisenmenger reaction was present in 9% of the 709 patients. The frequency of the Eisenmenger reaction was high in young patients and was not significantly different in patients in the first and second decades as compared to older patients. None of our patients with pulmonary hypertension resided at high altitude. The high frequency of pulmonary hypertension in our young patients cannot be satisfactorily explained. Autopsy studies suggest that in some, pulmonary hypertension is due to the persistence of the fetal pulmonary vascular pattern.