Abstract 3217: Long-Term Course in Adult Patients with Atrial Septal Defect and Pulmonary Hypertension Treated with Percutaneous Device Occlusion
BACKGROUND: Percutaneous device occlusion of secundum atrial septal defect (ASD) is an acceptedalternative to surgical closure. However, there is limited information on the immediate and long-term effects of percutaneous device occlusion for ASD in middle-aged or elderly patients (pts) with pulmonary hypertension (PHT).
METHODS : From a total of 212 pts with ASD treated with percutaneous device occlusion, we selected 40 adult pts (mean age 53 ± 16 years) with a baseline peak systolic pulmonary pressure (PSPP)> 40 mmHg. Before treatment, 10 pts (25%) were in functional class III-IV. Seven pts with a mean PSPP of 75±22 mmHg had a bi-directional shunt. An Amplatzer occluder (mean device diameter 28 ± 7.4 mm) was successfully implanted in all pts. After treatment, a close clinical follow-up was undertaken in all 40 pts. The last echo-Doppler evaluation was made at a mean follow-up time of 3.4±2.4 years.
RESULTS: There were no major complications. Complete ASD occlusion at discharge was observed by echo-Doppler in 37 pts (92%). One pt 72 years old died of heart failure and respiratory infection 30 months after treatment. At late follow-up, only 1 pt (2%) was in functional class III and 38 (96%) were in class I-II. One pt has a persistent residual shunt while the remaining 38 have complete ASD occlusion. The subgroup of pts with bi-directional shunt before treatment had significant further decrease in pulmonary pressure at late follow-up (36±20 mmHg; p<0.05).The figure⇓ shows the course of pulmonary pressure.
CONCLUSIONS: Most adult pts with ASD and PHT show a marked clinical and hemodynamic improvement after percutaneous treatment which is maintained to long-term follow-up.