Diagnosis and Surgical Treatment of a Foramen Ovale Defect in Older Patients Complicated by Pulmonary Artery Hypertension

Abstract

Atrial septal defect (ASD) is one of the most common congenital heart defects in adult patients, accounting for all congenital heart defects — ASD) is one of the most common congenital heart defects in adults, accounting for 10–15 percent of all congenital heart defects and 25–30 percent of congenital heart defects diagnosed for the first time in adulthood. Its long-term undiagnosed course leads to chronic increases in pulmonary blood flow, causing pulmonary vasculature remodeling and the development of pulmonary artery hypertension (PAH), which significantly complicates the treatment strategy. This article reviews modern diagnostic methods for BADN complicated by PAH in adult patients—transthoracic and transesophageal echocardiography, right heart catheterization, assessment of pulmonary vascular resistance (PVR) — as well as treatment tactics, including percutaneous and surgical closure, and the “treat and repair” strategy used in severe PAH cases, are analyzed. In a retrospective registry of 632 patients, PH20 (mean pulmonary arterial pressure >20 mm Hg) was identified in 56.8% of patients before BADN closure, In the study of 117 patients, PAH normalization was observed in 80% of cases after transcatheter closure, and in a meta-analysis of 1,073 patients, PH prevalence decreased from 44% to 18% post-closure. The results obtained confirm the clinical importance of early diagnosis of BADN complicated by PAH and the selection of individualized treatment tactics.