Percutaneous atrial septal defect closure in patients with pulmonary arterial hypertension
Authors: Estibaliz Valdeolmillos, Claire Foray, Gregoire Albenque, Clément Batteux, Jerome Petit, Florence Lecerf, Xavier Jaïs, Olivier Sitbon, David Montani, Laurent Savale, Marc Humbert, Sébastien Hascoët
Journal: European Respiratory Journal (2024)

Pulmonary arterial hypertension (PAH) is a dreaded, although rare, complication of uncorrected atrial septal defect (ASD), one of the most common congenital heart diseases [1]. Most patients with ASD undergo early transcatheter closure, which is the reference standard treatment of ASD and prevents PAH development. The optimal management of patients with ASD and PAH is controversial [2, 3]. When the PAH is severe, surgical closure has produced poor outcomes [4–6], whereas transcatheter closure after lung transplantation (transplant-and-repair strategy) has been found beneficial [7]. The 2022 ESC/ERS guidelines stipulate that ASD closure should be considered only when pulmonary vascular resistance (PVR) is below 5 Wood units (WU) [3]. However, transcatheter shunt closure seems possible in selected patients with higher PVR values, particularly after PAH-specific treatment (PAHST) (treat-and-repair strategy), although the data come only from small cohorts and current recommendations rely primarily on expert opinion [6, 8–10]. Prospective studies are needed to further assess this strategy. In the present study, we aimed to assess short-term and long-term outcomes of patients managed by transcatheter ASD closure for persistent left-to-right shunting with PAH. Footnotes This manuscript has recently been accepted for publication in the ERJ Open Research . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article. Conflict of Interest: Estibalis Valdeolmillos, Claire Foray, Gregoire Albenque, Clement Batteaux report support for the present manuscript from Abbott. In addition, these authors report travel support from Edwards; outside the submitted work. Conflict of Interest: Jerome Petit reports travel support from Edwards; outside the submitted work. Conflict of Interest: David Montani reports grants from Acceleron, Janssen, Merck MSD; consulting fees from Acceleron, Merck MSD, Janssen, Ferrer; lecture honoraria from Bayer, Janssen, Boerhinger, Chiesi, GSK, Ferrer, Merck MSD; outside the submitted work. Conflict of Interest: Marc Humbert reports grants from Acceleron, AOP Orphan, Janssen, Merck, Shou Ti; consulting fees from Acceleron, Aerovate, Altavant, AOP Orphan, Bayer, Chiesi, Ferrer, Janssen, Merck, MorphogenIX, Shou Ti, Tiakis, United Therapeutics; lecture honoraria from Janssen, Merck; advisory board participation from Acceleron, Altavant, Janssen, Merck, United Therapeutics; outside the submitted work. Conflict of Interest: Sebastien Hascoet reports support for the present manuscript from Abbott. In addition, Sebastien Hascoet reports consulting fees from Abbott, Edwards lifesciences; travel support from Edwards; advisory board participation with Abbott, Venus medtech; and a leadership role as Secretary for FCPC; outside the submitted work. Conflict of Interest: Olivier Sitbon reports grants from Aerovate, AOP Orphan, Ferrer, Janssen, MSD; consulting fees from Altavant/Enzyvant, AOP Orphan, Ferrer, Gossamer Bio, Janssen, MSD, Respira Therapeutics; lecture honoraria from AOP Orphan, Janssen, Ferrer, MSD; advisory board participation from Altavant/Enzyvant, Gossamer Bio, Janssen; outside the submitted work. Conflict of Interest: Xavier Jais reports grants from Acceleron, Janssen, MSD, Bayer HealthCare; consulting fees and lecture honoraria from MSD; outside the submitted work. Conflict of Interest: All other authors have nothing to disclose.