Seol Jae-Hee, Jung Se-Yong, Lee Han-Byul, Kim Ah-Young, Kim Eun-Hwa, Min In-Kyung, Kim Nam-Kyun, Choi Jae-Young
Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
J Clin Med. 2023 Mar 28;12(7):2540. doi: 10.3390/jcm12072540.
Pulmonary arterial hypertension (PAH) related to an atrial septal defect (ASD) poses a challenge to transcatheter closure of an ASD (tcASD). We aimed to determine the predictors for remaining PAH (rPAH) post-tcASD. This retrospective study was conducted at a single tertiary university hospital. Adult patients with an ASD and PAH were divided into three groups according to pulmonary vascular resistance (PVR). Normalization of pulmonary atrial systolic pressure (PASP) was defined as an estimated right ventricular systolic pressure < 40 mmHg and was determined using transthoracic echocardiography. Among 119 patients, 80% showed PAH normalization post-tcASD. Normalization of PAH post-tcASD was observed in 100%, 56.2%, and 28.6% of patients in mild, moderate, and severe PVR groups, respectively. The patients' New York Heart Association functional class improved. Multivariate logistic regression analysis showed that age and high PVR were significant risk factors for rPAH. A receiving operator curve analysis showed a PASP cutoff value > 67.5 mmHg to be predictive of rPAH post-tcASD, with an area under the curve value of 0.944 (sensitivity, 0.922; specificity 0.933). Most patients, including moderate-to-severe PAH patients, improved hemodynamically and clinically with tcASD. Since patients with severe PAH are at a risk of rPAH, tcASD should be performed by selecting the patient carefully based on pre-procedure medication, a vasoreactivity test, and a balloon occlusion test.
与房间隔缺损（ASD）相关的肺动脉高压（PAH）对ASD的经导管封堵术（tcASD）构成挑战。我们旨在确定tcASD术后残留PAH（rPAH）的预测因素。这项回顾性研究在一家单一的三级大学医院进行。患有ASD和PAH的成年患者根据肺血管阻力（PVR）分为三组。肺动脉收缩压（PASP）正常化定义为估计的右心室收缩压<40 mmHg，并通过经胸超声心动图确定。在119例患者中，80%在tcASD术后显示PAH正常化。轻度、中度和重度PVR组患者的PAH正常化率分别为100%、56.2%和28.6%。患者的纽约心脏协会功能分级有所改善。多因素逻辑回归分析显示，年龄和高PVR是rPAH的显著危险因素。接受者操作曲线分析显示，PASP临界值>67.5 mmHg可预测tcASD术后的rPAH，曲线下面积值为0.944（敏感性为0.922；特异性为0.933）。大多数患者，包括中度至重度PAH患者，通过tcASD在血流动力学和临床方面都有改善。由于重度PAH患者有发生rPAH的风险，因此应在术前用药、血管反应性试验和球囊封堵试验的基础上仔细选择患者进行tcASD。
