Preoperative pharmacological management of a patient with ASD II and pulmonary hypertension forcardiac surgery
Streszczenie
The article presents the case of a 36-year-old woman referred to the Clinic of Cardiology at the Pomeranian Medical University with exertional dyspnoea that had been increasing for 2 years. Upon examination, the patient was diagnosed with an atrial septal defect type II (ASD II) with a left-to-right shunt and pulmonary hypertension. Echocardiography revealed a defect of 4.3 cm in diameter, right ventricular systolic pressure (RSVP) 80 mm Hg, tricuspid regurgitation. Right heart catheterization (RHC) revealed: mean pulmonary arterial pressure (mPAP) 59 mm Hg, pulmonary vascular resistance 10.22 Wood units (WU) and a negative vasoreactivity test. Following a cardiosurgical consultation, the patient was qualified for preliminary pharmacological treatment and re-examination. Sildenafil was included in the treatment, followed by macitentan. Improvement in exercise tolerance was observed [in the 6-minute walk test — from 440 to 526 m; clinically from New York Heart Association (NYHA) III to NYHA I/II] as well as a decrease in N-terminal pro-B-type natriuretic peptide concentration (from 250 to 170 pg/mL). Echocardiography showed a decrease in RVSP to 60 mm Hg. In RHC performed after one year of treatment, mPAP decreased to 40 mm Hg, PVR decreased to 3.25 WU, and cardiac output increased from 5.57 to 10.44 L/min. Mixed venous oxygen saturation increased from 64.5% to 72.5%. After another cardiosurgical consultation, the patient was qualified for surgery. Closure of ASD II was performed with a pericardial patch and completed with tricuspid valve plasty. The peri-and postoperative period was uneventful, and the clinical and echocardiographic follow-up confirmed the positive effects of the treatment.
Słowa kluczowe: pulmonary hypertensionatrial septal defectclosure
Referencje
- Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Kardiol Pol. 2015; 73(12): 1127–1206.
- Prochownik P, Przewłocki T, Podolec P, et al. Improvement of physical capacity in patients undergoing transcatheter closure of atrial septal defects. Post Kardiol Interw. 2018; 14(1): 90–94.
- Komar M, Przewlocki T, Olszowska M, et al. The benefit of atrial septal defect closure in elderly patients. Clin Interv Aging. 2014; 9: 1101–1107.
- Baumgartner H, De Backer J, Babu-Narayan SV, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021; 42(6): 563–645.
- Baumgartner H, Bonhoeffer P, De Groot NMS, et al. Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC), Association for European Paediatric Cardiology (AEPC), ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010; 31(23): 2915–2957.
- Taniguchi Yu, Emoto N, Miyagawa K, et al. Subsequent shunt closure after targeted medical therapy can be an effective strategy for secundum atrial septal defect with severe pulmonary arterial hypertension: two case reports : strategy for ASD with severe PAH. Heart Vessels. 2014; 29(2): 282–285.
- Park YK, Park JH, Yu JH, et al. Transient use of oral bosentan can be an additional option to reduce pulmonary arterial hypertension in a patient with severe pulmonary arterial hypertension associated with atrial septal defect. J Cardiovasc Ultrasound. 2011; 19(3): 159–162.
- Kim YH, Yu JJ, Yun TJ, et al. Repair of atrial septal defect with Eisenmenger syndrome after long-term sildenafil therapy. Ann Thorac Surg. 2010; 89(5): 1629–1630.
