From the Guidelines
Right heart catheterization is indicated in patients with Atrial Septal Defect (ASD) when noninvasive imaging is insufficient to estimate pulmonary artery pressures and shunt magnitude, or to determine detailed hemodynamics for decision-making, particularly in those with reduced functional capacity presumed caused by hemodynamically important secundum ASD 1. The primary goal of right heart catheterization in ASD patients is to assess the severity of the defect and its impact on cardiac function, which is crucial for guiding treatment decisions.
- Key indications for right heart catheterization in ASD patients include:
- Inconclusive or discrepant noninvasive imaging data
- Need for detailed hemodynamic assessment to guide treatment decisions
- Presence of reduced functional capacity presumed caused by hemodynamically important secundum ASD
- Evaluation of pulmonary artery pressures and shunt magnitude
- According to the 2018 AHA/ACC guideline for the management of adults with congenital heart disease, patients with ASD who undergo closure have improved functional status and potentially improved long-term outcomes, whereas those who do not undergo closure may experience worse long-term outcomes, including more atrial arrhythmias, reduced functional capacity, and eventually greater degrees of PAH 1.
- It is essential to note that older adults should be evaluated for left atrial hypertension resulting from diastolic dysfunction, which may cause similar symptoms but could result in clinical worsening after ASD closure 1.
- The procedure itself is generally low-risk, with complications occurring in less than 1% of cases, and provides crucial information about ASD severity and associated hemodynamic consequences that cannot be obtained through non-invasive imaging alone.
From the Research
Indications for Right Heart Catheterization in Atrial Septal Defect (ASD)
The following are indications for right heart catheterization in a patient with ASD:
- To assess the severity of pulmonary hypertension and pulmonary vascular resistance, which is crucial in determining the treatment strategy for ASD 2, 3, 4, 5, 6
- To evaluate the hemodynamic effects of ASD closure and guide the management of patients with severe pulmonary hypertension 3, 4, 5, 6
- To monitor the response to treatment and adjust the management plan accordingly 4, 5, 6
- To assess the risk of right heart failure and guide the treatment strategy for patients with ASD and pulmonary hypertension 2, 3, 4, 5, 6
Key Considerations
When considering right heart catheterization in patients with ASD, the following factors should be taken into account:
- The presence and severity of pulmonary hypertension and pulmonary vascular resistance 2, 3, 4, 5, 6
- The size and location of the ASD 3, 4
- The presence of other cardiac anomalies or comorbidities 2, 3, 4, 5, 6
- The patient's symptoms and functional status 4, 5, 6
Hemodynamic Assessment
Right heart catheterization allows for the assessment of various hemodynamic parameters, including: