Page 15 - Journal of Structural Heart Disease Volume 3, Issue 4

Original Research Article
Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:102-106
DOI: https://doi.org/10.12945/j.jshd.2017.003.17
Received: January 18, 2017 Accepted: March 01, 2017 Published online: August 2017
Moderate Altitude Is Not Associated with Pulmonary Arterial Hypertension in Adult Patients Referred for Transcatheter Device Closure of Atrial Septal Defects
Jeremy Nicolarsen, MD1,2*, Brett Oestreich, MD1, Sonali S. Patel, MD2, Jamil Aboulhosn, MD3, Wayne J. Franklin, MD4, Joseph Kay, MD1,2
1 Department of Medicine, University of Colorado Hospital, Aurora, Colorado, USA
2 Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado, USA
3 Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
4 Departments of Medicine and Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
Abstract
Background:Pulmonaryarterialhypertension(PAH)oc- curs in 6–10% of adults with atrial septal defects (ASDs). Although larger defect size and older age are two risk factors for the development of PAH in these patients, little is known about the impact of elevation. Thus, we aimed to determine whether the incidence of PAH is higher among patients living at moderate altitude who are referred for transcatheter device closure of an ASD. Methods: Our multicenter, retrospective cohort study included patients at least 18 years of age who were re- ferred for device closure of an ASD (> 4 mm) during a 10-year period (2003–2013). Catheterization records from three centers were reviewed. Results: Thirty-seven moderate altitude (4983–5633 ft) and 126 low altitude (74–839 ft) patients were identi ed (p < 0.0001). After controlling for age, living at moderate altitude was asso- ciated with a greater likelihood of pulmonary hyperten- sion (odds ratio 2.29, 95% con dence interval 1.01–5.19, p = 0.046), but there was no such association with PAH (p = 0.9). Conclusion: Patients with ASD living at moderate altitude are more likely to exhibit pulmonary hyperten- sion but not PAH compared with patients living at sea level. Therefore, while moderate altitude can increase pulmonary pressures, it did not contribute to the devel- opment of PAH in our cohort of patients with ASDs. Copyright © 2017 Science International Corp.
Key Words:
Atrial septal defect • Pulmonary hypertension • Pulmonary arterial hypertension • Altitude
Introduction
Atrial septal defects (ASDs) represent 6–10% of all congenital heart defects [1]. Left unrepaired or if diagnosed later in life, ASDs are associated with pul- monary hypertension (PH, elevated pulmonary artery pressures) or pulmonary arterial hypertension (PAH, elevated pressures and pulmonary vascular disease with normal left heart pressures). The latter condi- tion results from years of left-to-right shunting and excessive pulmonary blood ow, which in turn can lead to irreversible pulmonary vascular remodeling characterized by medial hypertrophy, intimal thick- ening, and arteriolar muscularization [2]. Although ASDs cause a minority of cases of PAH associated with congenital heart disease [3, 4], progressive pulmonary vascular disease and elevated resistance can result in right heart failure, reversal of the intracardiac shunt, or Eisenmenger syndrome. Other morbidities can also arise in the setting of an unrepaired ASD, such as par- adoxical embolism and stroke due to transient right-
* Corresponding Author:
Jeremy Nicolarsen, MD
Providence Adult and Teen Congenital Heart Program (PATCH)
Providence Center for Congenital Heart Disease
Providence Sacred Heart Medical Center and Children’s Hospital
101 West 8th Avenue, Suite 4300, Spokane, WA 99204
Tel.: +1 509 474 6707; Fax: +1 509 624 9186; E-Mail: jeremy.nicolarsen@providence.org
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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