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Temperate approach to ASD closure in pulmonary arterial hypertension: the fenestrated patch technique

Part of: Surgery Atrial Septal Defect (ASD)

Published online by Cambridge University Press:  08 April 2021

Ergin Arslanoglu ,
Nihat Cine ,
Kenan Abdurrahman Kara Open the ORCID record for Kenan Abdurrahman Kara [Opens in a new window] ,
Abdullah Arif Yılmaz ,
Fatih Tomrukcu ,
Mehmet Bicer ,
Eylem Tuncer ,
Yasemin yavuz  and
Hakan Ceyran
Ergin Arslanoglu
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Nihat Cine
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Kenan Abdurrahman Kara*
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Abdullah Arif Yılmaz
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Fatih Tomrukcu
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Mehmet Bicer
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Eylem Tuncer
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Yasemin yavuz
Affiliation:
Anaesthesia and Reanimation Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
Hakan Ceyran
Affiliation:
Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
*
Author for correspondence: Kenan Abdurrahman Kara, MD, Associate Professor, Pediatric Cardiovascular Surgery Department, Kartal Kosuyolu High Speciality Educational and Research Hospital, Denizer street, No.2, Kartal 34865, İstanbul, Turkey. Tel: +905300655225; Fax: +902163390441. E-mail: kenankaradoc@gmail.com
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Abstract

The most common CHD in the adult patient population is an atrial septal defect due to its asymptomatic nature in early life. However, when diagnosis and treatment are delayed, pulmonary arterial hypertension may develop as a long-term complication, sometimes before adulthood. The presence of PAH adversely affects the results of surgical treatment and may even eliminate the feasibility of surgery in some patients. In such patients who have high pulmonary artery pressure and pulmonary vascular resistance at the margin of inoperability, the response to the acute vasoreactivity test determines the treatment modality.

In our retrospective study, a total of 906 patients who underwent ASD closure between January, 2011 and November, 2020, seven of which had undergone the fenestrated patch procedure after they were identified to have high PAP, but positive AVT test response were included. Short-term follow-up of patients with fenestrated ASD patches revealed decreased pulmonary pressure, regression in NYHA classification, and improvement in symptoms.

The fenestrated patch technique should be kept in mind as an option to expand the surgical spectrum in the treatment of patients with high pulmonary pressures, where complete closure is risky. It appears that the fenestrated patch technique is a safe approach in the management of pulmonary hypertension in patients with ASD who have pulmonary hypertension, according to short- and midterm follow-up findings.

Keywords

Congenital heart diseaseatrial septal defectfenestrated patch techniquepulmonary hypertensionacute vasoreactivity test
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 12 , December 2021 , pp. 1953 - 1957
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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