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To seal or to vent? Hemodynamic-guided decision-making in an older patient with borderline large secundum atrial septal defect and pulmonary hypertension
Heart Science Journal · Vol. 7 No. 3 (2026) · hlm. 105–108
- ISSN
- 2721-9984, 2721-9976
- Terbit
- 2026-07-14
- Penerbit
- Universitas Brawijaya
- Bahasa
- en
Abstrak
Background: Determining whether an atrial septal defect (ASD) should be closed in older patients who already have pulmonary hypertension may present a clinical dilemma. This is particularly true when pulmonary vascular resistance (PVR) approaches commonly used operability thresholds. Case Illustrations: A 59-year-old woman was referred to our center because of progressive exertional dyspnea and declining functional capacity. Echocardiography evaluation showed a large secundum ASD with a significant left-to-right shunt and right-sided chamber enlargement. Right heart catheterization revealed a mean pulmonary artery pressure of 46 mmHg and a pulmonary vascular resistance of 7.1 Wood units. Following oxygen test, PVR decreased to 3.4 Wood units and the Qp/Qs ratio increased from 1.5 to 2.65, suggesting preserved pulmonary vascular responsiveness. Based on these findings, transcatheter ASD closure without fenestration was performed successfully. The intervention was completed without complications, and early follow-up showed improvement in symptoms along with more favorable hemodynamic findings. Conclusions: This case highlights how comprehensive hemodynamic and physiological assessment, including dynamic vasoreactivity testing, can guide operability decisions in older patients with ASD and elevated PVR. Reassessment of pulmonary vascular responsiveness may refine risk stratification and support individualized management.
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28 penulis · 112 tautan kepenulisan bersama · 6 lintas organisasi
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- University of Brawijaya
- RSUD Prof. Dr. Saiful Anwar Malang
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| Rekan penulis | Organisasi | Artikel bersama |
|---|---|---|
| Anna Fuji Rahimah | University of Brawijaya | 4 |
| Wella Karolina | University of Brawijaya | 4 |
| Heny Martini | University of Brawijaya | 4 |
| Setyasih Anjarwani | University of Brawijaya | 3 |
| Indra Prasetya | University of Brawijaya | 3 |
| Cholid Tri Tjahjono | University of Brawijaya | 3 |
| Mohammad Saifur Rohman | University of Brawijaya | 2 |
| Ardian Rizal | University of Brawijaya | 2 |
| Novi Rahmawati | RSUD Prof. Dr. Saiful Anwar Malang | 2 |
| Stefani Harumsari | Afiliasi tidak diketahui | 1 |
| Nugrahanti Prasetyorini | Afiliasi tidak diketahui | 1 |
| Pande Made Dwijayasa | Afiliasi tidak diketahui | 1 |
| Bambang Rahardjo | University of Brawijaya | 1 |
| Budi Satrijo | University of Brawijaya | 1 |
| Dea Arie Kurniawan | University of Brawijaya | 1 |
| Nikhen Noverike | University of Brawijaya | 1 |
| Akhmad Isna Nurudinulloh | University of Brawijaya | 1 |
| Vemmy Lian Saputri | University of Brawijaya | 1 |
| Muhammad Firdaus | University of Brawijaya | 1 |
| Indra Jabbar Aziz | University of Brawijaya | 1 |
| Danti Utami Setyowati | RSUD Prof. Dr. Saiful Anwar Malang | 1 |
| Akita Rukmana Akbar | University of Brawijaya | 1 |
| Anastasia Christine | Afiliasi tidak diketahui | 1 |
| Yosafat Hasiholan Marthin Gultom | University of Brawijaya | 1 |
| Muhammad Azhar Rosyidi | University of Brawijaya | 1 |
| Muhammad Reva Aditya | University of Brawijaya | 1 |
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