Combination of F-ASO and Targeted Medical Therapy in Patients With Secundum ASD and Severe PAH
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
OBJECTIVES: This study was conducted to investigate the combined use of fenestrated atrial septal occluder (F-ASO) and targeted medical therapy (TMT) in patients with secundum atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH).
BACKGROUND: Treatment of patients with ASD and severe PAH is still challenging.
METHODS: After ethical approval was obtained, 56 consecutive patients with ASD with severe PAH were included (7 men, 49 women; median age 50.5 years; mean ASD size 26.9 ± 4.6 mm). After 3 months of TMT, transcatheter closure was performed using F-ASO in patients with ratios of pulmonary to systemic blood flow ≥1.5. TMT was continued post-operatively together with 6 months of dual-antiplatelet therapy. The hemodynamic variables during baseline, TMT alone, and combined treatment with F-ASO were compared.
RESULTS: After only TMT, systolic pulmonary arterial pressure (-14.5 mm Hg; p < 0.001), pulmonary vascular resistance (-3.9 Wood units; p < 0.001), and exercise capacity (+72.0 m; p < 0.001) improved. Ratio of pulmonary to systemic blood flow increased by 0.9 (p < 0.001), with adverse cardiac remodeling (right ventricular dimension +3.5 mm; p < 0.001). Closure with F-ASO (median size 34.0 mm) led to further decrease in systolic pulmonary artery pressure (-6.0 mm Hg; p < 0.001). Follow-up (median duration 10 months) revealed further improvement in exercise capacity (+60.5 m; p < 0.001), with favorable cardiac remodeling (right ventricular dimension -9.9 mm; p < 0.001). In addition, all fenestrations were stable (p = 0.699), with negligible shunt (median ratio of pulmonary to systemic blood flow 1.1) and no complications. One year later, pulmonary artery pressure was normalized in 8 of 19 patients, and PAH recurred in 5 patients after discontinuation of TMT.
CONCLUSIONS: In patients with ASD and severe PAH, combination of F-ASO and TMT was a safe and effective procedure. Compared with TMT alone, the combined treatment further improved exercise capacity, with favorable cardiac remodeling.
| Errataetall: |
CommentIn: JACC Cardiovasc Interv. 2020 Sep 14;13(17):2035-2037. - PMID 32800499 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
JACC. Cardiovascular interventions - 13(2020), 17 vom: 14. Sept., Seite 2024-2034 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Yan, Chaowu [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 05.04.2021 Date Revised 05.04.2021 published: Print-Electronic CommentIn: JACC Cardiovasc Interv. 2020 Sep 14;13(17):2035-2037. - PMID 32800499 Citation Status MEDLINE |
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| doi: |
10.1016/j.jcin.2020.04.027 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM313751110 |
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| 245 | 1 | 0 | |a Combination of F-ASO and Targeted Medical Therapy in Patients With Secundum ASD and Severe PAH |
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| 500 | |a Date Completed 05.04.2021 | ||
| 500 | |a Date Revised 05.04.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: JACC Cardiovasc Interv. 2020 Sep 14;13(17):2035-2037. - PMID 32800499 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: This study was conducted to investigate the combined use of fenestrated atrial septal occluder (F-ASO) and targeted medical therapy (TMT) in patients with secundum atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH) | ||
| 520 | |a BACKGROUND: Treatment of patients with ASD and severe PAH is still challenging | ||
| 520 | |a METHODS: After ethical approval was obtained, 56 consecutive patients with ASD with severe PAH were included (7 men, 49 women; median age 50.5 years; mean ASD size 26.9 ± 4.6 mm). After 3 months of TMT, transcatheter closure was performed using F-ASO in patients with ratios of pulmonary to systemic blood flow ≥1.5. TMT was continued post-operatively together with 6 months of dual-antiplatelet therapy. The hemodynamic variables during baseline, TMT alone, and combined treatment with F-ASO were compared | ||
| 520 | |a RESULTS: After only TMT, systolic pulmonary arterial pressure (-14.5 mm Hg; p < 0.001), pulmonary vascular resistance (-3.9 Wood units; p < 0.001), and exercise capacity (+72.0 m; p < 0.001) improved. Ratio of pulmonary to systemic blood flow increased by 0.9 (p < 0.001), with adverse cardiac remodeling (right ventricular dimension +3.5 mm; p < 0.001). Closure with F-ASO (median size 34.0 mm) led to further decrease in systolic pulmonary artery pressure (-6.0 mm Hg; p < 0.001). Follow-up (median duration 10 months) revealed further improvement in exercise capacity (+60.5 m; p < 0.001), with favorable cardiac remodeling (right ventricular dimension -9.9 mm; p < 0.001). In addition, all fenestrations were stable (p = 0.699), with negligible shunt (median ratio of pulmonary to systemic blood flow 1.1) and no complications. One year later, pulmonary artery pressure was normalized in 8 of 19 patients, and PAH recurred in 5 patients after discontinuation of TMT | ||
| 520 | |a CONCLUSIONS: In patients with ASD and severe PAH, combination of F-ASO and TMT was a safe and effective procedure. Compared with TMT alone, the combined treatment further improved exercise capacity, with favorable cardiac remodeling | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a fenestration | |
| 650 | 4 | |a pulmonary arterial hypertension | |
| 650 | 4 | |a secundum atrial septal defect | |
| 650 | 4 | |a targeted medical therapy | |
| 650 | 4 | |a transcatheter closure | |
| 650 | 7 | |a Antihypertensive Agents |2 NLM | |
| 700 | 1 | |a Pan, Xiangbin |e verfasserin |4 aut | |
| 700 | 1 | |a Wan, Linyuan |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Hua |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Shiguo |e verfasserin |4 aut | |
| 700 | 1 | |a Song, Huijun |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Qiong |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Fengwen |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Yao |e verfasserin |4 aut | |
| 700 | 1 | |a Jiang, Yong |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Lei |e verfasserin |4 aut | |
| 700 | 1 | |a Fang, Wei |e verfasserin |4 aut | |
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