Abstract
Concomitant systemic essential hypertension (HTN) in adults with a secundum atrial septal defect (ASD) can unfavorably affect the hemodynamics and transcatheter ASD closure (ASDC) effects. This study aims to assess the effectiveness and safety of ASDC in adults with HTN in real-world clinical practice. Right ventricular (RV) reverse remodeling (RVR) and the lack of a left-to-right interatrial residual shunt (NoRS) in echocardiography 24 h and 6 months (6 M) post-ASDC, and ASDC-related complications within 6 M were evaluated in 184 adults: 79 with HTN (HTN+) and 105 without HTN (HTN−). Compared to HTN−, HTN+ patients were older and had a greater RV size and the prevalence of atrial arrhythmias, chronic heart failure, nonobstructive coronary artery disease, diabetes, hyperlipidemia, and left ventricular diastolic dysfunction. ASDC was successful and resulted in RVR, NoRS, and a lack of ASDC-related complications in the majority of HTN+ patients both at 24 h and 6 M. HTN+ and HTN− did not differ in ASD size, a successful implantation rate (98.7% vs. 99%), RVR 24 h (46.8% vs. 46.7%) and 6 M (59.4% vs. 67.9%) post-ASDC, NoRS 24 h (79% vs. 81.5%) and 6 M (76.6% vs. 86.9%) post-ASDC, and the composite of RVR and NoRS at 6 M (43.8% vs. 57.1%). Most ASDC-related complications in HTN+ occurred within 24 h and were minor; however, major complications such as device embolization within 24 h and mitral regurgitation within 6 M were observed. No differences between HTN+ and HTN− were observed in the total (12.7% vs. 9.5%) and major (5.1% vs. 4.8%) complications. Transcatheter ASDC is effective and safe in adults with secundum ASD and concomitant HTN in real-world clinical practice; however, proper preprocedural management and regular long-term follow-up post-ASDC are required.
Highlights
An ostium secundum atrial septal defect (ASD) is a common congenital heart defect in adults, which can result in an increased risk of heart failure (HF) and premature death [1–5]
The underlying hemodynamic disturbance in a secundum ASD is the presence of a left-to-right interatrial shunt, leading to a right ventricle (RV) volume overload and increased pulmonary flow volume, which over time can result in RV enlargement, pulmonary arterial hypertension (PAH), atrial arrhythmias, chronic HF, and thromboembolic complications [2,4–8]
HTN can lead to left ventricular (LV) hypertrophy (LVH), an abnormal LV compliance, and LV dysfunction, which may interfere with the disturbed hemodynamics associated with ASD [9]
Summary
An ostium secundum atrial septal defect (ASD) is a common congenital heart defect in adults, which can result in an increased risk of heart failure (HF) and premature death [1–5]. Due to the ageing population, a number of patients with adult congenital heart disease (ACHD) continue to increase, including patients at an advanced age and/or with cardiovascular (CV) risk factors and acquired comorbidities, such as other CV diseases (CVDs) [9–11]. HTN becomes progressively more common with an advancing age, reaching >60% in people aged >60 years [11,12,15] Acquired comorbidities, such as HTN, are common in adults with ACHD, and can significantly contribute to their outcome [9–11]. Concomitant HTN in adults with secundum ASD can aggravate hemodynamic disturbances, especially in older adults with a significant interatrial shunt and abnormal LV compliance
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