Author + information
- Received December 3, 2019
- Revision received April 7, 2020
- Accepted April 14, 2020
- Published online September 7, 2020.
- Chaowu Yan, PhD, MDa,∗ (, )
- Xiangbin Pan, PhD, MDa,
- Linyuan Wan, PhD, MDa,
- Hua Li, MDb,
- Shiguo Li, PhD, MDa,
- Huijun Song, PhD, MDa,
- Qiong Liu, PhD, MDa,
- Fengwen Zhang, PhD, MDa,
- Yao Liu, PhD, MDa,
- Yong Jiang, PhD, MDa,
- Lei Wang, PhD, MDc and
- Wei Fang, PhD, MDc
- aDepartment of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- bDepartment of Cardiology, Beijing TongRen Hospital, Beijing, China
- cDepartment of Nuclear Medicine, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- ↵∗Address for correspondence:
Dr. Yan Chaowu, Department of Structural Heart Disease, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, China.
Objectives This study was conducted to investigate the combined use of fenestrated atrial septal occluder (F-ASO) and targeted medical therapy (TMT) in patients with secundum atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH).
Background Treatment of patients with ASD and severe PAH is still challenging.
Methods After ethical approval was obtained, 56 consecutive patients with ASD with severe PAH were included (7 men, 49 women; median age 50.5 years; mean ASD size 26.9 ± 4.6 mm). After 3 months of TMT, transcatheter closure was performed using F-ASO in patients with ratios of pulmonary to systemic blood flow ≥1.5. TMT was continued post-operatively together with 6 months of dual-antiplatelet therapy. The hemodynamic variables during baseline, TMT alone, and combined treatment with F-ASO were compared.
Results After only TMT, systolic pulmonary arterial pressure (−14.5 mm Hg; p < 0.001), pulmonary vascular resistance (−3.9 Wood units; p < 0.001), and exercise capacity (+72.0 m; p < 0.001) improved. Ratio of pulmonary to systemic blood flow increased by 0.9 (p < 0.001), with adverse cardiac remodeling (right ventricular dimension +3.5 mm; p < 0.001). Closure with F-ASO (median size 34.0 mm) led to further decrease in systolic pulmonary artery pressure (−6.0 mm Hg; p < 0.001). Follow-up (median duration 10 months) revealed further improvement in exercise capacity (+60.5 m; p < 0.001), with favorable cardiac remodeling (right ventricular dimension −9.9 mm; p < 0.001). In addition, all fenestrations were stable (p = 0.699), with negligible shunt (median ratio of pulmonary to systemic blood flow 1.1) and no complications. One year later, pulmonary artery pressure was normalized in 8 of 19 patients, and PAH recurred in 5 patients after discontinuation of TMT.
Conclusions In patients with ASD and severe PAH, combination of F-ASO and TMT was a safe and effective procedure. Compared with TMT alone, the combined treatment further improved exercise capacity, with favorable cardiac remodeling.
- pulmonary arterial hypertension
- secundum atrial septal defect
- targeted medical therapy
- transcatheter closure
This work was supported by National Natural Science Foundation of China (81670283, 61975240) and the Beijing Municipal Science & Technology Commission (Z171100001017194). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 3, 2019.
- Revision received April 7, 2020.
- Accepted April 14, 2020.
- 2020 American College of Cardiology Foundation
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