A different view on predictors of pulmonary hypertension in secundum atrial septal defect

- Pulmonary hypertension is common in secundum ASD patients, even after ASD closure.
- Age at ASD repair is the most important predictor for PH development.
- Patients younger than 55 years at ASD closure clearly had a better outcome afterwards.
- In patients with late ASD repair, the risk of PH is high and clinical outcome worse.

Background/objectivesPulmonary arterial hypertension is an important complication in hemodynamically relevant atrial septal defects (ASD) and negatively affects outcome. This retrospective study aimed at (1) estimating the prevalence of pulmonary hypertension (PH) in patients with secundum ASD and (2) identifying predictors of PH development or persistence after ASD closure.MethodsConsecutive patients with an isolated secundum ASD from the Belgian Registry on Adult Congenital Heart Disease were studied. Demographic, clinical, echocardiographic and invasive hemodynamic measurements were analyzed. PH was defined upon the echocardiographic PH probability (tricuspid regurgitation velocity ≥ 2.9 m/s).ResultsPH prevalence in the entire ASD population (295 patients, 68.8% females, mean age 46 ± 21 years) was 15.9% compared to 13.3% in patients after ASD closure. PH after ASD closure was significantly related to mortality (p = 0.001), atrial arrhythmia (p < 0.001) and right heart failure (p = 0.019). Age at repair was the most important predictor for PH (HR 1.11). In the highest tertile of age at repair (> 55 years), PH prevalence was the highest (34%) and mean pulmonary artery pressure (mPAP) at catheterization before was related to PH after closure (HR 1.09). Twenty patients in the PH group had mPAP < 25 mm Hg before closure.ConclusionsPH in closed secundum ASD patients is not uncommon. Its prevalence was the highest when the defect was repaired above 55 years of age. Clinical outcome was worse. PH may even develop despite normal mPAP before closure. The present findings raise the question whether the cutoff value for mPAP before closure should be age-adjusted.