Treatment of Atrial Septal Defect with Pulmonary Vascular Resistance ≥5 WU

Elevated pulmonary vascular resistance in the setting of atrial septal defect defines a distinct and clinically important sub-population that requires a carefully sequenced management approach before any consideration of closure.

Clinical scenario: Atrial septal defect in a patient with pulmonary vascular resistance ≥5 Wood Units (WU). This level of elevated resistance places the patient in a group where straightforward defect closure is not the immediate step.

Approach

The protocol centres on targeted pulmonary arterial hypertension treatment, followed by re-evaluation of haemodynamics during follow-up. What happens next — and the precise conditions under which further intervention may be reconsidered — is detailed in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehaa554

In patients with PVR ≥5 WU, fenestrated ASD closure may be considered when PVR falls below 5 WU after targeted PAH treatment and significant LR shunt is present (Qp:Qs >1.5).

It appears safer to treat PAH, re-evaluate haemodynamics during follow-up, and consider fenestrated closure only when PVR falls below 5 WU in the presence of significant LR shunt.

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