Author + information
- Yasufumi Kijima,
- Teiji Akagi,
- Koji Nakagawa,
- Akira Ueoka,
- Norihisa Toh,
- Kengo Kusano and
- Hiroshi Ito
Therapeutic strategy for atrial septal defect (ASD) patients with severe pulmonary artery hypertension (PAH) still remains controversial. Recent advances in medical therapy for PAH and catheter intervention may provide new therapeutic approaches in these patients.
Among 628 ASD patients who underwent successful catheter closure of ASD using Amplatzer Septal Occluder, 10 patients with severe PAH (mean pulmonary artery pressure ⊠40 mmHg) were studied. Before ASD closure, six patients were indicated ASD closure with normal medication such as diuretics (NM group). Meanwhile, remaining 4 patients were required advanced medical therapies (AM group). Advanced medical therapy included intravenous or oral prostanoids (n=2), phosphodieterase type 5 inhibitors (n=2), endothelin receptor antagonists (n=4). In AM group, catheter closure of ASD was performed after confirmation of therapeutic efficacy for PAH.
Median device size was 30 mm (range from 10 mm to 38 mm). Tricuspid regurgitation pressure gradient (TRPG) significantly decreased on the follow–up period of >3 months (85 mmHg vs. 43 mmHg, p<0.04, N=6). In the AM group, significant decrease of TRPG was confirmed after the advanced medical therapy and further reduction of TRPG was also confirmed after the catheter closure of ASD (Figure).
Combination of advanced medical therapy and catheter intervention may expand the therapeutic indication in patients with ASD and severe PAH.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 51. TCT@ACC–i2: Non–valvular Structural Heart Disease
Presentation Number: 2114–254
- 2013 American College of Cardiology Foundation