Association between pulmonary hypertension and an atrial septal defect

An ASD is a relatively common congenital heart disease with a birth prevalence of 1.6 per 1000 live births, and a probability of survival into adulthood of 97 % [2, 3]. Different types of ASDs exist, and the secundum type, located at the fossa ovalis, is the most common (75 %) [4]. An ASD is characterised by a left-to-right shunt with volume overload of the right heart and pulmonary overcirculation. This might result in arrhythmias, right heart failure, pulmonary arterial hypertension, and paradoxical embolism, the last mentioned due to a right-to-left shunt. Echocardiography is the primary diagnostic technique, and cardiac catheterisation is required in cases of a suspected increase in pulmonary artery pressure (PAP). Indication for ASD closure is the presence of a significant shunt with signs of right ventricular volume overload without the presence of a severely increased pulmonary vascular resistance (PVR) (<5 Woods units) [5]. Percutaneous closure has become the first choice of treatment for secundum-type ASDs. Severe complications occurred in less than 1 % [6].