Key result
Transcatheter atrial septal closure after IV epoprostenol linked to symptom improvement without exacerbating pulmonary hypertension.
Why the study?
Optimal management strategies for patients with atrial septal defect and severe pulmonary hypertension remain unclear, particularly regarding combined epoprostenol therapy and septal defect closure.
Does transcatheter atrial septal closure after lowering pulmonary vascular resistance by intravenous epoprostenol improve symptoms in patients with ASD accompanied by severe PH?
Case Report (n=1)
Does transcatheter atrial septal closure after lowering pulmonary vascular resistance by intravenous epoprostenol improve symptoms in patients with ASD accompanied by severe PH?
Transcatheter atrial septal closure after lowering pulmonary vascular resistance with intravenous epoprostenol may be an effective novel therapy for patients with ASD and severe pulmonary hypertension.
Answers are grounded in this paper and cite their sources.
May support staged PH therapy before ASD closure in select cases; leaves open need for prospective validation.
A 31-year-old woman with exertional dyspnea diagnosed as having atrial septal defect (ASD) with severe pulmonary hypertension (PH). Intravenous epoprostenol therapy was started to improve PH. Although pulmonary arterial pressure decreased, her symptoms remained in class III of WHO functional class, probably because of exacerbation of the left-to-right shunt caused by the reduction of pulmonary vascular resistance (PVR). Transcatheter atrial septal closure was therefore performed. Soon after the procedure, additional reduction in pulmonary arterial pressure was achieved. Her symptoms improved and oxygen inhalation was discontinued. One year after the procedure, although intravenous epoprostenol was still required, her symptoms had improved to class I of WHO functional class without exacerbation of PH. Transcatheter atrial septal closure after lowering PVR by intravenous epoprostenol would be a novel therapy for patients with ASD accompanied by PH.
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Hirabayashi et al. (2008) conducted a case report in Atrial septal defect with severe pulmonary hypertension (n=1). Intravenous epoprostenol therapy and transcatheter atrial septal closure was evaluated on Symptom improvement (WHO functional class) and pulmonary arterial pressure reduction. Transcatheter atrial septal closure after lowering pulmonary vascular resistance by intravenous epoprostenol improved symptoms to WHO functional class I without exacerbation of pulmonary hypertension.
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