Severe and Apparently Irreversible Pulmonary Arterial Hypertension in a Patient with Ostium Secundum Atrial Septal Defect - A Successful Case of Treat and Close Strategy.
Alexandra BriosaFilipa FerreiraJoão SantosSofia AlegriaMaria José LoureiroDébora RepolhoHélder PereiraPublished in: Clinical medicine insights. Circulatory, respiratory and pulmonary medicine (2022)
Irreversible pulmonary arterial hypertension is considered a contraindication for surgical or percutaneous closure of atrial septal defects (ASD) due to risk of right heart failure. We present a case of 37 years-old woman who was referred to our center due to progressive worsening fatigue and high probability of pulmonary hypertension on a transthoracic echocardiogram. The diagnostic work-up revealed the presence of an ostium secundum atrial septal defect and severe pre-capillary pulmonary hypertension on right heart cathetherization (RHC). The patient was considered inoperable and started medical therapy with sildenafil and bosentan. After one year of treatment, she repeated RHC that showed a significant reduction in pulmonary vascular resistance making her eligible for closure. Surgical closure of ASD with a fenestra was performed with success. Our case emphasizes the importance of individual assessment even if cases where initial evaluation is unfavorable to closure in accordance with the guidelines.
Keyphrases
- pulmonary arterial hypertension
- pulmonary hypertension
- pulmonary artery
- atrial fibrillation
- heart failure
- autism spectrum disorder
- case report
- left atrial
- attention deficit hyperactivity disorder
- catheter ablation
- early onset
- healthcare
- multiple sclerosis
- minimally invasive
- left ventricular
- drug induced
- ultrasound guided
- clinical practice
- bone marrow
- squamous cell carcinoma
- physical activity
- hypertrophic cardiomyopathy
- coronary artery
- combination therapy
- working memory