Atrial septal defects and pulmonary hemodynamics: a time for holey reflection

摘要

Pulmonary vascular disease is a feared complication of atrial septal defects and other congenital shunt lesions. In the absence of intervention, irreversible pulmonary arterial hypertension (PAH) may develop in approx10-20% of people born with a clinically appreciated atrial septal defect (ASD) (5). The he-modynamic impact of increased pulmonary blood flow plays a role in predisposing to PAH (6), but there must be other contributors. While clinical characteristics, including age and defect size, affect the probability of developing PAH, the association is surprisingly weak. Some patients with a large ASD live a long life without developing PAH.