Summary by Bennett Samuel, M.H.A., B.S.N., R.N.
Pulmonary hypertension (PH) is a type of high blood pressure. PH affects the blood vessels in the lungs and heart. An atrial septal defect (ASD) is a hole in the wall between the two upper chambers of the heart (atria). PH affects 8-10% of all patients with this heart defect. This condition is known as atrial septal defect–associated pulmonary hypertension (ASDAPH). This research study reports the use of an ASD closure device in patients with ASDAPH.
Complete closure is risky as it can increase the pressure in the blood vessels from the heart to the lungs. High pressure in these blood vessels makes the right heart (ventricle) work harder to pump blood to the lungs. Overworking the heart may cause right heart failure and other medical problems. Fenestrated (partial) closure allows for blood to be pumped more normally through the heart, with the small fenestration (or hole) providing relief (i.e., a “safety valve”) for the heart when there are increases in pulmonary artery pressures or pulmonary vascular resistance (PVR). A device called Occlutech® Fenestrated Atrial Septal Defect (FASD) Occluder allows for partial closure of ASDs. In an article appearing in the official journal of the Pulmonary Hypertension Association, Advances in Pulmonary Hypertension (Kaley et al., 2019), we reported on our experience placing the device in the heart of 42 ASDAPH patients around the world. Follow-up data was available on 25 patients.
Prior to device placement, 17 (68.0%) patients were New York Heart Association (NYHA) functional class III, while only three (13.0%) patients were functional class III up to six months after device placement. There was decrease in right heart and pulmonary artery pressures. One patient needed an emergency procedure to reopen the device fenestration that had closed by itself. There were no other major medical problems. More studies are needed in a large group of patients. The goal of future studies is to learn about the best timing for device placement, fenestration size and longterm outcomes.
To read the full article and other research about PH in congenital heart disease, visit the Advances in Pulmonary Hypertension website. Author Bennett Samuel is a clinical research nurse at Spectrum Health’s Congenital Heart Center of Helen DeVos Children’s Hospital in Grand Rapids, Mich.
Vishal Kaley, Nagib Dahdah, Amal El-Sisi, Jochen Grohmann, Eric Rosenthal, Matthew Jones, Gareth Morgan, Nicholas Hayes, Ashish Shah, Cemsit Karakurt, Masood Sadiq, Matthias Sigler, Hans Figulla, Michael Becker, Nikolaus Haas, Eustaquio Onorato, Angel Puentes Rico, Supaporn Roymanee, Anselm Uebing, Walter Wiebe, Bennett Samuel, Ziyad Hijazi, and Joseph Vettukattil. (2019.) Atrial Septal Defect–Associated Pulmonary Hypertension: Outcomes of Closure With a Fenestrated Device. Advances in Pulmonary Hypertension. 2019, Vol. 18, No. 1, pp. 4-9. https://doi.org/10.21693/1933-088X-18.1.4