Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-26T15:08:28.706Z Has data issue: false hasContentIssue false
  • English
  • Français

Temperate approach to ASD closure in pulmonary arterial hypertension: the fenestrated patch technique

Part of: Surgery Atrial Septal Defect (ASD)

Published online by Cambridge University Press:  08 April 2021

Ergin Arslanoglu ,
Nihat Cine ,
Kenan Abdurrahman Kara Open the ORCID record for Kenan Abdurrahman Kara [Opens in a new window] ,
Abdullah Arif Yılmaz ,
Fatih Tomrukcu ,
Mehmet Bicer ,
Eylem Tuncer ,
Yasemin yavuz  and
Hakan Ceyran
Ergin Arslanoglu
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Nihat Cine
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Kenan Abdurrahman Kara*
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Abdullah Arif Yılmaz
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Fatih Tomrukcu
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Mehmet Bicer
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Eylem Tuncer
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Yasemin yavuz
Affiliation:
Anaesthesia and Reanimation Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Hakan Ceyran
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
*
Author for correspondence: Kenan Abdurrahman Kara, MD, Associate Professor, Pediatric Cardiovascular Surgery Department, Kartal Kosuyolu High Speciality Educational and Research Hospital, Denizer street, No.2, Kartal 34865, İstanbul, Turkey. Tel: +905300655225; Fax: +902163390441. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The most common CHD in the adult patient population is an atrial septal defect due to its asymptomatic nature in early life. However, when diagnosis and treatment are delayed, pulmonary arterial hypertension may develop as a long-term complication, sometimes before adulthood. The presence of PAH adversely affects the results of surgical treatment and may even eliminate the feasibility of surgery in some patients. In such patients who have high pulmonary artery pressure and pulmonary vascular resistance at the margin of inoperability, the response to the acute vasoreactivity test determines the treatment modality.

In our retrospective study, a total of 906 patients who underwent ASD closure between January, 2011 and November, 2020, seven of which had undergone the fenestrated patch procedure after they were identified to have high PAP, but positive AVT test response were included. Short-term follow-up of patients with fenestrated ASD patches revealed decreased pulmonary pressure, regression in NYHA classification, and improvement in symptoms.

The fenestrated patch technique should be kept in mind as an option to expand the surgical spectrum in the treatment of patients with high pulmonary pressures, where complete closure is risky. It appears that the fenestrated patch technique is a safe approach in the management of pulmonary hypertension in patients with ASD who have pulmonary hypertension, according to short- and midterm follow-up findings.

Keywords

Congenital heart diseaseatrial septal defectfenestrated patch techniquepulmonary hypertensionacute vasoreactivity test
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 12 , December 2021 , pp. 1953 - 1957
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Helgason, H, Jonsdottir, G. Spontaneous closure of atrial septal defects. Pediatr Cardiol 1999; 20: 195–199.CrossRefGoogle ScholarPubMed
Hanslik, A, Pospisil, U, Salzer-Muhar, U, et al. Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. Pediatrics 2006; 118: 1560–1565.10.1542/peds.2005-3037CrossRefGoogle ScholarPubMed
Hoeper, MM, Bogaard, HJ, Condliffe, R, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 2013; 62 (25 Suppl): D42–D50.10.1016/j.jacc.2013.10.032CrossRefGoogle ScholarPubMed
Yong, G, Khairy, P, De Guise, P, et al. Pulmonary arterial hypertension in patients with transcatheter closure of secundum atrial septal defects: a longitudinal study. Circ Cardiovasc Interv 2009; 2: 455–462.10.1161/CIRCINTERVENTIONS.108.826560CrossRefGoogle ScholarPubMed
Hirabayashi, A, Miyaji, K, Akagi, T. Continuous epoprostenol therapy and septal defect closure in a patient with severe pulmonary hypertension. Catheter Cardiovasc Interv 2009; 73: 688–691.10.1002/ccd.21877CrossRefGoogle Scholar
Gibbon, JH Jr Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 1954; 37: 171–185.Google ScholarPubMed
Khan, JH, McElhinney, DB, Reddy, VM, Hanley, FL. A 5-year experience with surgical repair of atrial septal defect employing limited exposure. Cardiol Young 1999; 9: 572–576.CrossRefGoogle ScholarPubMed
Doll, N, Walther, T, Falk, V, et al. Secundum ASD closure using a right lateral minithoracotomy: five year experience in 122 patients. Ann Thorac Surg 2003; 75: 1527–1530.10.1016/S0003-4975(02)04889-0CrossRefGoogle ScholarPubMed
Barbero-Marcial, M, Tanamati, C, Jatene, MB, Atik, E, Jantene, AD. Transxiphoid approach without median sternotomy for the repair of atrial septal defects. Ann Thorac Surg 1998; 65: 771–774.10.1016/S0003-4975(97)01433-1CrossRefGoogle ScholarPubMed
Grinda, JM, Folliguet, TA, Dervanian, P, Mace, L, Legault, B, Neveux, J. Right anterolateral thoracotomy for repair of atrial septal defect. Ann Thorac Surg 1996; 62: 175–178.10.1016/0003-4975(96)00182-8CrossRefGoogle ScholarPubMed
Laks, H, Hammond, GA. Cosmetically acceptable incision for the median sternotomy. Ann Thorac Surg 1980; 62: 1100–1103.Google Scholar
Mavroudis, C. VATS ASD closure: a time not yet come. Ann Thorac Surg 1996; 62: 638–639.CrossRefGoogle Scholar
Hopkins, RA, Bert, AA, Buchholz, B, Guarino, K, Meyers, M. Surgical patch closure of atrial septal defects. Ann Thorac Surg 2004; 77: 2144–2149; author reply 2149-50. doi: 10.1016/j.athoracsur.2003.10.105.CrossRefGoogle ScholarPubMed
Holzer, R, Cao, QL, Hijazi, ZM. Closure of a moderately large atrial septal defect with a selffabricated fenestrated Amplatzer septal occluder in an 85-year-old patient with reduced diastolic elasticity of the left ventricle. Catheter Cardiovasc Interv 2005; 64: 513–518.10.1002/ccd.20315CrossRefGoogle Scholar
Engelfriet, P, Mulder, BJ. Gender differences in adult congenital heart disease. Neth Heart J 2009; 17: 414–417. doi: 10.1007/BF03086294.CrossRefGoogle ScholarPubMed
Sezer, S, Özyurt, A, Narin, N, et al.. The immediate haemodynamic response and right and left cardiac remodelling after percutaneous transcatheter closure of secundum atrial septal defect in children: A longitudinal cohort study. Cardiol Young. 2021: 1–8. doi: 10.1017/S1047951121000500.Google ScholarPubMed
Schneider, HE, Jux, C, Kriebel, T, Paul, T. Fate of a modified fenestration of atrial septal occluder device after transcatheter closure of atrial septal defects in elderly patients. J Interv Cardiol 2011; 24: 485–490.CrossRefGoogle ScholarPubMed
Peters, B, Ewert, P, Schubert, S, et al. Self-fabricated fenestrated Amplatzer occluders for transcatheter closure of atrial septal defect in patients with left ventricular restriction: midterm results. Clin Res Cardiol 2006; 95: 88–92.10.1007/s00392-006-0329-3CrossRefGoogle ScholarPubMed
Arvind, B, Relan, J, Kothari, SS. “Treat and repair” strategy for shunt lesions: a critical review. Pulm Circ. 2020; 10: 2045894020917885. doi: 10.1177/2045894020917885.CrossRefGoogle ScholarPubMed
Lowe, BS, Therrien, J, Ionescu-Ittu, R, et al. Diagnosis of pulmonary hypertension in the congenital heart disease adult population impact on outcomes. J Am Coll Cardiol 2011; 58: 538–546.10.1016/j.jacc.2011.03.033CrossRefGoogle ScholarPubMed
Warnes, CA. Sex differences in congenital heart disease: should a woman be more like a man? Circulation 2008; 118: 3–5. doi: 10.1161/CIRCULATIONAHA.108.785899.CrossRefGoogle ScholarPubMed
Martin, YN, Pabelick, CM. Sex differences in the pulmonary circulation: implications for pulmonary hypertension. Am J Physiol Heart Circ Physiol 2014; 306: H1253–H1264. doi: 10.1152/ajpheart.00857.2013.CrossRefGoogle ScholarPubMed
Hansmann, G, Koestenberger, M, Alastalo, TP, et al. 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT. J Heart Lung Transplant. 2019; 38: 879–901. doi: 10.1016/j.healun.2019.06.022.CrossRefGoogle Scholar