Outcomes of Partial Closure with Fenestrated Device in Atrial Septal Defect Accompanied by Severe Pulmonary Hypertension : A Literature Review

Author : P. Prasetyo, R. Prakoso
Upload Date : 19-04-2018

Background: Closure of Atrial Septal Defect (ASD) in patient with severe pulmonary arterial hypertension (PAH) remains controversial since a critical rise in pulmonary pressure (PH crisis) could be fatal. Recently, partial closure with a customized fenestrated device has given the possibility to close defects in patients previously considered inoperable. The aim of this study is to describe the outcomes of ASD closure with fenestrated device in patients with severe pulmonary hypertension. 

Method: Journal searching in PubMed and MEDLINE database from 2003 to 2018 was conducted. Results from 3 case series of patients with fenestrated devices comprising 26 patients were included in this analysis. The primary outcomes were functional capacity and reduction of mean pulmonary artery pressure (mPAP).

Results: All of case series in this review showed a consistent result. The pooled of improved functional capacity rate was 92%. The mean of mPAP pre closure was 35.15 (8.3-58) mmHg and the mean of mPAP post closure was 31.71 (7.8-58) mmHg. The significant reduction rate of mPAP pre and post closure (>20% reduction) was 42%.

Conclusion: Partial closure of ASD-PH with a fenestrated device showed a promising result in improvement of functional capacity and reduction of pulmonary artery pressure. However a close follow up in a further large multicenter study shoud be made to support these practices, especially in Indonesia and other South East Asia countries.

KEYWORDS : atrial septal defect, pulmonary hypertension, transcatheter closure, fenestrated device

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