Hemodynamic Follow-Up in Adult Patients with Pulmonary Hypertension Associated with Atrial Septal Defect after Partial Closure.

Purpose: We evaluated the hemodynamic statuses of patients after partial closure of atrial septal defects with fenestration due to pulmonary hypertension. Materials and Methods: Seventeen adult patients underwent partial atrial septal defect closure and follow-up cardiac catheterization. We analyzed hemodynamic data and clinical parameters before and after closure. Results: The median age at closure was 29 years old. The baseline Qp/Qs was 1.9 +/- 0.6. The median interval from the operation to the cardiac catheterization was 27 months. The CT ratio decreased from 0.55 +/- 0.07 to 0.48 +/- 0.06 (p<0.05). The mean pulmonary arterial pressure decreased from 50.0 +/- 11.5 mm Hg to 32.5 +/- 14.4 mm Hg (p<0.05), and the pulmonary resistance index decreased from 9.2 +/- 3.6 Wood units*m(2) to 6.3 +/- 3.8 Wood units*m(2) (p<0.05). Eleven patients (64.7%) continued to exhibit high pulmonary resistance (over 3.0 Wood units*m(2)) after closure. These patients had significantly higher pulmonary resistance indices and mean pulmonary arterial pressures based on oxygen testing before the partial closures (p<0.05). However, no significant predictors of post-closure pulmonary hypertension were identified. Conclusion: Despite improvement in symptoms and hemodynamics after partial closure of an atrial septal defect, pulmonary hypertension should be monitored carefully.