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Master Thesis

Évolution à long terme des patients atteints d'hypertension artérielle pulmonaire après fermeture percutanée de communication inter-atriale ostium secundum

Abstract : Introduction: Pulmonary arterial hypertension (PAH) is a formidable late complication of ostium secundum atrial septal defect (OS ASD). The value of percutaneous closure of the ASD in this situation is uncertain and controversial. We studied the long-term outcome of patients with PAH and ASD remote from closure. Methods and Results: In a retrospective, single-center cohort of 2047 patients who had ASD closure, 17 patients with PAH, without specific treatment, who had a complete hemodynamic evaluation before defect closure were included (mean age 43 years; 88.2% female; BMPR2 mutation, n=1; HIV, n=1; portal hypertension, n=1; scleroderma, n=1). One-year and long-term follow-ups were collected. Before closure, hemodynamic parameters were: Pulmonary Vascular Resistance (PVR) 5.7 (3.5 to 10.1) WU; mean pulmonary artery pressure (mPAP) 46mmHg (30 to 51) mmHg; Qp/Qs 2 (1.3 to 3). The procedures were performed without significant complications. At 1 year, there was a decrease in mPAP (median -16 mmHg, -2 to -28, p=0.004), of PVR (median -2, from -3.7 to +1 WU, p= 0.014). After a mean follow-up of 5.6 years, 1 patient died of PAH, 9 years after the procedure. At term 9 patients still had PAH, 7 of them under specific treatment, stabilized in "low risk" prognostic class. The levels of mPAP and PVR remain significantly lower than at baseline. Conclusion: In very selected patients with ASD, PVR<10 WU and persistence of a very significant left right shunt, closure of the ASD appears beneficial in the long term.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03563226
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Submitted on : Wednesday, February 9, 2022 - 3:19:56 PM
Last modification on : Saturday, April 2, 2022 - 3:38:36 AM

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  • HAL Id : dumas-03563226, version 1

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Claire Foray. Évolution à long terme des patients atteints d'hypertension artérielle pulmonaire après fermeture percutanée de communication inter-atriale ostium secundum. Médecine humaine et pathologie. 2021. ⟨dumas-03563226⟩

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