Abstract
Background: Pulmonary arterial hypertension (PAH) is a major complication of atrial septal defect
(ASD) and can be responsible for significant functional limitations and early mortality.
Various factors have been shown to predispose ASD patients to the development of PAH.
Our study aimed to determine the association between the size of the ASD, the age
of the patient and the increase in pulmonary artery pressures. Methods: Data from 74 ASD patients was retrospectively reviewed, including the patients' presenting
symptoms, vital parameters, comorbidities, as well as their preoperative diagnostic
workup. Echocardiography findings were used to determine the type and size of the
ASD, and pulmonary artery pressures were evaluated using tricuspid regurgitation velocity
as assessed by echocardiography or based on cardiac catheterization data. All patients
underwent ASD repair either surgically or via percutaneous repair. Univariate and
multivariate linear regression was performed to analyze the effect of age and defect
size on pulmonary artery pressures. Model adequacy check was also done for the final
model. Postoperative morbidity/mortality was additionally evaluated. Results: The study sample comprised 44.6 % males and 55.4 % females. The most prominent presenting
features were shortness of breath (70.3 %), chest pain (43.2 %), and palpitations
(33.8 %), and arterial hypertension was the commonest morbidity. Using multiple linear
regression analysis, age and size of ASD were found to be independently associated
with pulmonary artery pressure. We found that for every 1 mm increase in the size
of the ASD, pulmonary artery systolic pressure (PASP) increased by 0.32 mmHg (p ≤ 0.05). Similarly, with every increase of one year in age, pulmonary artery pressure
increased by 0.24 mmHg (p ≤ 0.02). No significant postoperative complications were reported following both
types of repair. Conclusions: Our study concludes that ASD patients are at greater risk of developing PAH with
increasing age and increasing ASD size. This can potentially help to determine which
ASD patients are at greater risk and require urgent repair of their defects. The study
also shows that early repair is best to prevent complications.
Key words
cardiovascular surgery - atrial septal defect - pulmonary hypertension - ostium secundum
atrial septal defect - postoperative complications
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Dr. Afaq Motiwala
Department of Medicine
Aga Khan University
Stadium Road, P.O Box 3500
74800 Karachi
Pakistan
Phone: +92 33 32 49 27 26
Fax: +92 21 32 72 24 61
Email: afaqmotiwala@gmail.com