{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T12:58:02Z","timestamp":1773061082780,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,10,22]],"date-time":"2018-10-22T00:00:00Z","timestamp":1540166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe a subset of atrial septal defect (ASD) with severe pulmonary hypertension (PHT) that is suitable for closure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>As per American Heart Association\/American College of Cardiology guidelines, ASD with elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) &gt;2\/3rd systemic is considered as a contraindication for closure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with anatomically large ASD measuring &gt;25\u2009mm and a high probability of reversible pulmonary vascular disease were subjected to fenestrated device closure, despite severe PHT and elevated PVR. They were discharged on pulmonary vasodilators and were followed for 39.5 \u00b1 8.5 months. Four patients had repeat cardiac catheterization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six patients underwent successful device closure of large ASD with severe PHT. Their basal Qp:Qs was 2.8 \u00b1 0.3:1 while the systolic PAP and the PVR index (PVRI) were 102.6 \u00b1\u200911.5 mm Hg and 9.6 \u00b1 1.6 Wu\u2009m<jats:sup>2<\/jats:sup>, respectively. Post 100% oxygen inhalation, the Qp:Qs increased to 3.5 \u00b1 0.3:1, systolic PAP remained 103.5 \u00b1 7.6 mm Hg while the PVRI dropped to 5.4 \u00b1 1.1\u2009Wu\u2009m<jats:sup>2<\/jats:sup>. The postballoon occlusion systolic PAP decreased to 86.6 \u00b1 8.8 mm Hg. At the last follow\u2010up, their pulmonary artery systolic pressure by tricuspid regurgitation (TR) jet decreased from 105.6 \u00b1\u200912.6 mm Hg to 45\u2009\u00b1 7.0 mm Hg. During follow\u2010up cardiac catheterization (<jats:italic>n<\/jats:italic> = 4), the systolic PAP and PVRI were 55.7 \u00b1 9.2 mm Hg and 3.2 \u00b1 0.4, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with anatomically big defect and a large left to right shunt at baseline with a high probability of reversible PVR benefit with ASD closure and pulmonary vasodilators, despite significantly elevated PAP and PVRI.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.27853","type":"journal-article","created":{"date-parts":[[2018,10,22]],"date-time":"2018-10-22T10:09:34Z","timestamp":1540202974000},"page":"309-315","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Device closure of atrial septal defect with severe pulmonary hypertension in adults: Patient selection with early and intermediate term 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