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Opposite Effects of ASD Closure in Pediatric Patients with Pulmonary Arterial Hypertension (PAH) Treated with Vasodilators: Example of 2 Case Reports

Hanaa Banjar

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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Hanaa Banjar, MD, FRCPC.

King Faisal Specialist Hospital and research Center, Riyadh, Saudi Arabia

CASE (1)Referred at a age 1 ½ year with history of Triplet pregnancy and C/S delivery, Prem 34 weeks, Chronic lung disease (CLD), O2 dependant, Failure to thrive (FTT), chocking with feeding, monthly admission for chest infection, ASD with severe PAH , Pulmonary artery pressure (PAP)=65 mmHg. MRI brain (N).

The patient was treated with diuretics, O2, GT feeding, Nissen-fundolpication, Antibiotics prohylaxis for recurrent aspiration, Sildenafil for 4 years, 5 admissions to close ASD were failed due to high PAP

At age 3 years had upper air way obstruction due to large adenoid, PAP > 40, Added Iloprost nebulization, and under went for Tonsillectomy and adenoidectomy.

At around 5 years of age, her PAP < 30 mmHg, and PR < 6, Went for ASD device closure Successfully

PAP after procedure remained < 30 mmHg. At Age 5 1/2 years, ECHO was normal

CASE II: Referred at a age 1 ½ year with history Prematurity 34 weeks, Chronic lung disease (CLD), O2 dependant, Failure to thrive (FTT), chocking with feeding, monthly admission for chest infection, ASD with severe PAH , Pulmonary artery pressure (PAP)=65 mmHg. MRI brain (N)

Treated with diuretics, O2. Nasogstric tube feeding until the age of 3 years. Antibiotics prohylaxis for recurrent aspiration, Sildenafil for 6 years, in addition to Bosentan for 3 years. At 7 years of age his ECHO showed PAP of <25 mmHg. He was admitted to close ASD, cardiac cath showed mean PAP of 28mmHg, PCWP= 10mmHg, Pulmonary vascular Resistance was low ( 237.2 d/s/cm-5), and QP:QS of 1.8-2 : 1. A trial to close his ASD failed as his PAP increased during the procedure.

CONCLUSIONASD closure in patients with CLD and Pulmonary hypertension needs to be assessed in case to case bases. In some patients it might be life saving.