Usefulness of mean pulmonary artery pressure for predicting outcomes of transcatheter closure of atrial septal defect with pulmonary arterial hypertension

Aims: This study aimed to provide a simple index for predicting the definitive indication for transcatheter closure of atrial septal defect (ASD) with pulmonary arterial hypertension (PAH).

Methods and results: A positive response after attempted occlusion was defined as mean pulmonary artery pressure (MPAP) ≤30 mmHg or the decrement percentage of it ≥20% compared with baseline. If a positive response was achieved, the occluder would be released, and the procedure was defined as successful. In 209 patients who underwent a successful procedure without PAH-specific medicine, there was a dramatic decrease in the percentage of patients with pulmonary arterial systolic pressure (PASP) ≥50 mmHg from baseline to the one-year follow-up (79.4% to 14.0%, p<0.001). The optimal cut-off value of MPAP to predict a positive response without PAH-specific medicine was 35.0 mmHg, with an area under the curve (AUC) of 0.919 (p<0.001). Administration of inhaled iloprost extended the cut-off point to 50.0 mmHg to reach a positive response, with an AUC of 0.774 (p=0.003).

Conclusions: This large-scale study indicated that MPAP could be a simple but powerful index to predict benefit from closure in adult ASD patients with PAH.