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All Journal Politico: Jurnal Ilmu Politik Jurnal Pertanian Agros Heart Science Journal Madani: Multidisciplinary Scientific Journal Neraca: Jurnal Ekonomi, Manajemen dan Akuntansi Socius: Social Sciences Research Journal Media Hukum Indonesia (MHI) Jurnal Kreatif : Karya Pengabdian untuk Masyarakat Aktif dan Inovatif
Tambunan, Daniel
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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 Tambunan, Daniel; Valerinna Yogibuana
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.18

Abstract

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.
Co-Authors Akbar, Maulana Muhammad Andhiyo, Immanuel Given Bintang Bachtiar, Muhammad Rizky Christy, Giovanni Darussalam, Rezky Fabyo Deswita, Adelia Dina Oktaviana Febridha, Salsabillah Hadhani, Muhammad Gading Bintang Handhani, Muhammad Gading Bintang Harley, Airiique Bintang Merah Herley, Airiique Bintang Merah Hibatullah, Abdurrafi Julio, Christopher Elia Kurniawan, Nur Arief Lestari, Widya Nadjima, Aulia Rachmatullah Nandita, Lufna Nirwana, Rena Putri Nurdin, Aulia Anjani Putro, Alberto Muhammad Gusti RAMADHAN, ADITYA RIZKY Ramadhan, Niko Rafael Rasyad, Pasha Athallah S, Subakdi Sabu, Wani Samual, Rifaizal Saputra, Septian Sugiarta Sariski, Aldo Simajorang, Dianingtas Hartono Sitanggang, Kamsia Dorliana Tanjung, Salsas Bila Juniyanti Valerinna Yogibuana Winata, Henry Zalsabilla, Zara Zyasky Zulfikar, Faiz Raudhin