Progressive pulmonary hypertension post atrial septal defect device closure-early symptomatic improvement may not predict outcome.

Background: For patients with an atrial septal defect and pulmonary hypertension it can be difficult to determine whether it is safe to intervene. With newer treatments for pulmonary hypertension and transcatheter techniques avoiding surgical stressors, it has been hoped that we can occlude previously inoperable defects safely.
Methods: We undertook a subgroup analysis of outcomes for patients with mean pulmonary artery pressure (PAp) ≥30mmHg from within our database of patients undergoing transcatheter ASD closure from 1997 to 2004.
Results: Data for 11 patients were reviewed. Mean age of the patients at intervention was 38 years (5-69 years). Eight patients have had symptomatic improvement with no evidence of progressive pulmonary hypertension. There was one death due to unrelated causes. Two patients have developed progressive pulmonary vascular disease with one death.
Conclusions: Despite early symptomatic improvement, adverse outcomes may occur in patients with elevated pulmonary vascular resistance undergoing transcatheter ASD closure. Careful haemodynamic evaluation is vital. Modest elevation of pulmonary vascular resistance and the presence of left to right shunt (Qp:Qs>1.5:1) are reassuring.
(Copyright © 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier B.V. All rights reserved.)