Open Access

ARTICLE

Hemodynamic, biological, and right ventricular functional changes following intraatrial shunt repair in patients with flow-induced pulmonary hypertension

Chih-Hsin Hsu^1,2, Jun-Neng Roan^1,3, Jieh-Neng Wang⁴, Chien-Chi Huang⁵, Chao-Jung Shih³, Jyh-Hong Chen^2,6, Jing-Ming Wu⁴, Chen-Fuh Lam^7,8

1 Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2 Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
3 Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
4 Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
5 Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
6 Department of Internal Medicine, China Medical University, Taichung, Taiwan
7 Department of Anesthesiology, China Medical University, Taichung, Taiwan
8 Department of Anesthesiology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

* Corresponding Author: Chen-Fuh Lam, Department of Anesthesiology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, 252, Wu-Xing Street, Taipei, 110 Taiwan. Email:

Congenital Heart Disease 2017, 12(4), 533-539. https://doi.org/10.1111/chd.12479

Abstract

Objectives: Atrial septal defects may result in pulmonary hypertension and right heart remodeling. We analyzed improvements in patients with flow-induced pulmonary hypertension and the activation of endothelial progenitor cells after flow reduction.
Design: This prospective cohort study included 37 patients who were admitted for an occluder implantation. Blood samples were collected before and after the procedure. We determined the number of endothelial progenitor cells in outgrowth colonies and serum Hsp27 concentrations. Daily performance and cardiothoracic ratio were reevaluated later.
Results: Closure of the defect significantly reduced the pulmonary pressure and B-type natriuretic peptide levels. The cardiothoracic ratio and daily performance status also improved. The number of endothelial progenitor cell outgrowth colony-forming units significantly increased and was positively correlated with daily performance. In patients with enhanced colony formation, Hsp27 levels were significantly increased.
Conclusions: The implantation of an occluder successfully improved hemodynamic, right ventricular, and daily performance. Qualitative enhancement of colony formation for endothelial progenitor cells was also noted and positively correlated with daily performance. Closure of defects may serve as a valid, reliable model to obtain a deeper understanding of the modulation of endothelial progenitor cell activity and its relationship with pulmonary hypertension prognosis.

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Keywords

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