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Ann Thorac Surg 2001;72:906-907
© 2001 The Society of Thoracic Surgeons

Case report: invited commentary

Invited commentary

Robyn Barst, MDa

a Pulmonary Hypertension Center, Division of Pediatric Cardiology, New York Presbyterian Medical Center, 3959 Broadway, BHN-2, New York, NY 10032, USA

e-mail: rjb3@columbia.edu

Yamauchi and colleagues report "successful" repair of an atrial septal defect in a 35-year-old female patient with an atrial septal defect and pulmonary vascular disease, who apparently improved postoperatively clinically as well as hemodynamically from the standpoint of her pulmonary arterial hypertension. Although I would agree with the authors that patients who have pulmonary vascular disease associated with congential heart defects should be repaired if they are "operable," the criteria for "operability," specifically with respect to complete repair versus leaving a residual defect, such as a small "atrial septal defect" remains unclear. Our experience has been that many patients with severe pulmonary hypertension associated with atrial septal defects, such as the patient that the authors report, do significantly improve clinically for a number of years after closure of the atrial septal defect, although more often than not, they subsequently clinically deteriorate, . . . [Full Text of this Article]


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