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Q. Why is there pulmonary hypertension after ASD closure surgery?

Answered by
Dr. Divakara. P
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Dec 20, 2019

Hi doctor,

My wife has pulmonary hypertension after ASD closure surgery. Kindly advice.

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#

Hi,

Welcome to icliniq.com.

Did the pulmonary hypertension occur only after ASD closure? Before closure was there pulmonary hypertension? The treatment depends on the severity of hypertension. So, is her pulmonary hypertension mild moderate or severe? If you cannot tell about severity, kindly upload the reports so that I can go through and advise better.

Thank you doctor,

Her age is 28 now and had a 2 years baby. We came to know that she has ASD after the delivery. On the first echo done one week after delivery PAH is NIL but on the third month after delivery there is PAH+ in echo test.Also, surgeon told that we have to do the open heart surgery and he told that her condition is not suit for surgery now due to delivery. He suggested us to do after some (three moths) but we had to wait for one year and did minimally invasive surgery.

Yes, she had mild pulmonary hypertension before the surgery which is around 58 mmhg, immediately after the surgery it went to 100 mmhg.Now almost 3 months have passed. On her follow up echo RVSP is 70 mmhg which is still in severe PAH. Now she is taking Sildenifal 20 mg twice a day, Ddigoxin, Lasix and Pantacid. Now doctor prescribed a new tablet Endobloc. Kindly advise whether we are on the right way of the treatment or is there any alternate medicine for her to bring her PAH to normal. Since she has right heart dysfunction also. So I am literally worried. Kindly suggest whether her disease is life threatening or she will be back to normal soon and the final doubt is that with these medicine if her PAH will be back to normal, is there by any chance will it go back to mild or severe once again?

Symptoms which I can observe are sweating on upper lips and nose, while walking fastly on step, the lips turn to blue. Her lower abdomen is some what big compare to pre-surgery say by 2 inches by measurement.

#

Hi,

Welcome back to icliniq.com.

So this is a combined opinion of myself, a senior physician and a cardiologist. It is not expected for the PAH to worsen after correction of ASD, in fact it should come down. So either the estimation of pulmonary artery pressure or RVSP before surgery was wrong or there might having been some problem or insufficiency in the operation.

You have mentioned the RVSP after operation but it would be very useful if you can post her ECHO reports pre and post-operation. As of medication is concerned Sildenafil is the right medication but I feel the dosage could have been increased before going to Endobloc. A dose of 50 mg 2 times a day can be used. Even Endobloc is a good drug but if I was your doctor I would have increased Sildenafil dose before going to Endobloc.


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