Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Canada.
Circ Cardiovasc Interv. 2009 Oct;2(5):455-62. doi: 10.1161/CIRCINTERVENTIONS.108.826560. Epub 2009 Sep 22.
Pulmonary arterial hypertension (PAH) may develop in patients with atrial septal defects (ASD); however, little is known about associated risk factors and its evolution after transcatheter ASD closure.
We conducted a cohort study on 215 adults with attempted transcatheter ASD closure from 1999 to 2006. Patients were classified according to baseline systolic pulmonary artery pressures as having no (I, <40 mm Hg), mild (II, 40 to 49 mm Hg), moderate (III, 50 to 59 mm Hg), or severe (IV, >or=60 mm Hg) PAH. Independent predictors of moderate or severe PAH were older age (odds ratio [OR], 1.10 per year; P<0.0001), larger ASD (OR, 1.13 per millimeter; P=0.0052), female sex (OR, 3.9; P=0.0313), and at least moderate tricuspid regurgitation (OR, 3.6; P=0.0043). At 15 (interquartile range, 8 to 43) months post-ASD closure, patients with higher baseline pressures were more likely to experience a >or=5-mm Hg decrease (33.7%, 73.9%, 79.2%, and 100.0% in groups I to IV, P<0.0001), with a larger magnitude of reduction (0, 8, 17, and 22 mm Hg; P<0.0001). However, normalization of pressures (<40 mm Hg) occurred less frequently in patients with more advanced PAH (90.2%, 71.7%, 66.7%, and 23.5%, P<0.0001). Among patients with moderate or severe PAH, independent predictors of normalization were lower baseline pressures (OR, 0.91 per mm Hg; P=0.0418) and no more than mild tricuspid regurgitation (OR, 0.14; P=0.0420).
In adults with ASDs, severity of PAH is modulated by age, sex, defect size, and degree of tricuspid regurgitation. Patients with moderate or severe PAH may benefit from substantial reductions in pulmonary artery pressures after transcatheter ASD closure, although the PAH values remain elevated in a sizeable proportion.
房间隔缺损（ASD）患者可能会出现肺动脉高压（PAH）；然而，对于相关的危险因素及其经导管 ASD 封堵术后的演变，人们知之甚少。
我们对 1999 年至 2006 年间 215 例接受经导管 ASD 封堵术的成年人进行了一项队列研究。根据基线收缩期肺动脉压，患者被分为无（I 组，<40mmHg）、轻度（II 组，40-49mmHg）、中度（III 组，50-59mmHg）或重度（IV 组，≥60mmHg）PAH。中度或重度 PAH 的独立预测因素为年龄较大（比值比[OR]，每年增加 1.10；P<0.0001）、ASD 较大（OR，每毫米增加 1.13；P=0.0052）、女性（OR，3.9；P=0.0313）和至少中度三尖瓣反流（OR，3.6；P=0.0043）。在 ASD 封堵术后 15 个月（四分位间距，8 至 43 个月），基线压力较高的患者更有可能经历≥5mmHg 的下降（I 组至 IV 组分别为 33.7%、73.9%、79.2%和 100.0%，P<0.0001），且下降幅度更大（0、8、17 和 22mmHg；P<0.0001）。然而，在 PAH 程度较高的患者中，压力正常化（<40mmHg）的频率较低（I 组至 IV 组分别为 90.2%、71.7%、66.7%和 23.5%，P<0.0001）。在中度或重度 PAH 患者中，压力正常化的独立预测因素为较低的基线压力（OR，每 mmHg 降低 0.91；P=0.0418）和无或仅有轻度三尖瓣反流（OR，0.14；P=0.0420）。
在 ASD 患者中，PAH 的严重程度由年龄、性别、缺损大小和三尖瓣反流程度调节。中度或重度 PAH 患者经经导管 ASD 封堵术后肺动脉压可能会显著降低，尽管仍有相当一部分患者的 PAH 值升高。
