Transcript How do you manage this patient?

How do you manage this
patient?
Musni, Nallas, Naval
Evaluation of patient
• right heart catheterization
• severity of pulmonary hypertension and its reversibility
• measure pressure and oxygen saturation in SVC, IVC,
right atrium, right ventricle, pulmonary artery, and in
wedge position
• pulmonary vascular resistance (PVR):
– less than 7 wood units show regression of symptoms
– greater than 15 wood units have increased mortality
associated with closure of the ASD
• pulmonary artery vasodilators prior to surgery. (right-toleft shunt is reversible with pulmonary artery
vasodilators – Eisenmenger)
Management
• Medical
– Watch out for the development of complications:
• Arrythmias, CHF, endocarditis
• Operative repair
– Patch of pericardium or prosthetic material
– Percutaneous transcatheter device closure
Management
• Percutaneous transcatheter device closure
Indications:
symptomatic
significant L – R shunt
- Qp:Qs ≥1.5:1
- RA or RV enlargement
Management
• Results
– Surgical repair with mortality rates near zero
– Complications: atrial arrythmias, left atrial
hypertension
– Transcatheter closure
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Air embolism (1-3%)
Thromboembolism from device (1-2%)
Systemic pulmonary venous obstruction (1%)
Perforation of atrium/aorta (1-2%)
Atrial arrythmias (1-3 %)
Supportive Management
• Diet: No special diet is required.
• Activity: No activity restrictions are required except
for a few weeks following either device closure or
heart surgery.
Follow-up
• If the immediate postoperative echocardiogram confirms
complete closure, a follow-up visit one year following closure
is adequate to evaluate possible long-term complications
(rare)
• Patients who undergo closure of a large defect late in
childhood (when >8 y) should be advised to continue
infrequent cardiology evaluations with electrocardiographic
studies approximately every 5 years to monitor for the
possible occurrence of a dysrhythmia
• Patients who undergo device closure of a secundum atrial
septal defect should continue cardiology evaluations until
long-term published studies establish the absence of late
complications
• No medications are required, except bacterial endocarditis
prophylaxis for 6 months following either device or patch
closure