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Transient Balloon Occlusion to Identify a Patient with an Atrial Septal Defect (ASD) and Severe Pulmonary Hypertension Who Is a Candidate for Surgical Closure

Description

A small percentage of patients with an atrial septal defect (ASD) will develop severe pulmonary hypertension. Sanchez-Recalde et al used transient balloon occlusion of the ASD to determine if such a patient should undergo surgical closure of the defect or not. The authors are from Hospital Universitario La Paz in Madrid.


 

Severe pulmonary hypertension was defined as a right ventricular systolic pressure >= 70 mm Hg using echocardiography.

 

The prognosis for a patient with ASD and severe pulmonary hypertension is poor. In addition, surgery may be associated with significant morbidity and mortality. Therefore it is important to only perform surgery on someone who is likely to have a beneficial reduction in pulmonary pressures as a result of the surgery.

 

Procedure: transient balloon occlusion of the ASD

 

Criteria for a "positive" (beneficial) test:

(1) reduction in mean pulmonary arterial pressure >= 25% during the occlusion

(2) no fall in systemic pressures

(3) no increase in right ventricular end-diastolic pressure

 

percent reduction in mean pulmonary arterial pressure =

= ((pressure before in mm Hg) - (pressure after)) / (pressure before) * 100%

 


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