Page 17 - Journal of Structural Heart Disease Volume 3, Issue 4

Original Research Article
104
Table 1. Demographic data.
Moderate Altitude, n = 37
Low Altitude, n = 126
P
Male gender
Age (years)
Body surface area (m2)
Presence of lung disease
Presence of obstructive sleep apnea Taking PH medication
Elevation (ft)
PH = pulmonary hypertension
Defect size (mm) Qp:Qs
mPAp (mmHg) PCWp (mmHg) PVR (Wood units)
mPAp ≥ 25 mmHg PCWp ≤ 15 mmHg
PVR > 3 Wood units × m2
PH present† PAH present‡
11 (30%)
45 (35–61)
1.8 (1.7–2.1)
3 (8%)
1 (3%)
3/22 (25%)* 5334 (4983–5633)
20 (18–27) 1.5 (1.1–2.0) 25 (16–33) 11 (7–14) 1.8 (1.1–2.7)
20 (54%) 32 (86%) 6 (16%)
18 (50%) 5 (28%)
29 (23%) 36 (23–55) 1.8 (1.6–2.0) 2 (2%)
2 (2%) 13/22 (59%)* 246 (74–839)
22 (17–26) 1.6 (1.2–2.4) 19 (15–26) 10 (7–13) 1.1 (0.7–1.8)
37 (29%) 110 (87%) 17 (13%)
34 (27%) 10 (29%)
0.40 0.01 0.13 0.29 0.39 0.05
< 0.0001
0.61 0.07 0.05 0.82 0.008
0.006 0.90 0.68
0.010 0.90
Table 2. Catheterization data.
Moderate Altitude, n = 37
Low Altitude, n = 126
P
Qp:Qs = shunt fraction; mPAp = mean pulmonary artery pressure; PCWp = pulmonary capillary wedge pressure; PVR = pulmonary vascular resistance; PCWp = pulmonary capillary wedge pressure; PH = pulmonary hypertension; PAH = pulmonary arterial hypertension
†Criteria for PH: mPAp ≥ 25 mmHg only
‡Criteria for PAH: mPAp ≥ 25 mmHg, PCWp ≤ 15 mmHg, and PVR > 3 Wood units × m2
* Incomplete information was available for the entire cohort
(median mPAp 25 mmHg vs. 19 mmHg, p = 0.05), and PVR was signi cantly higher in the moderate altitude group than in the low altitude group (median PVR 1.8 vs. 1.1 Wood units × m2, p = 0.008).
When evaluating components of the clinical def- inition of PAH (i.e., mPAp ≥ 25 mmHg, PCWp ≤ 15 mmHg, and PVR > 3 Wood units × m2), we found a signi cant di erence in the prevalence of PH (mPAp ≥ 25 mmHg) between groups, even when control- ling for age (odds ratio 2.29, 95% con dence inter- val 1.01–5.19, p = 0.046). However, there was no dif- ference in the prevalence of PAH between groups (5/37 (28%) at moderate altitude vs. 10/126 (29%) at low altitude, p = 0.9).
Discussion
Although ASDs are a relatively small contributor to the overall prevalence of PAH in congenital heart dis- ease, signi cant morbidity can occur when these de- fects are unrepaired. Referral for transcatheter device closure remains an important part of the management of ASDs but requires an accurate assessment of Qp:Qs and PVR with right heart catheterization (RHC) before deciding on the need and safety of device closure. If PVR is signi cantly elevated (i.e., > 8 Wood units × m2 [11]) closure of the defect may result in pressure-over- load of the right ventricle with subsequent chamber enlargement and failure. By evaluating RHC data from a large cohort of patients who were referred for tran-
Journal of Structural Heart Disease, August 2017
Volume 3, Issue 4:102-106