Introduction Careful, stepwise assessment is required in all patients with atrial septal defect (ASD) to exclude pulmonary vascular or left ventricular (LV) disease. Fluid challenge and balloon occlusion may unmask LV disease and post-capillary pulmonary hypertension, but their role in the evaluation of patients with ‘operable’ ASDs is not well established. Methods We conducted a prospective study in three Italian specialist centres between 2018 and 2020. Patients selected for percutaneous ASD closure underwent assessment at baseline and after fluid challenge, balloon occlusion and both. Results Fifty patients (46 (38.2, 57.8) years, 72% female) were included. All had a shunt fraction >1.5, pulmonary vascular resistance (PVR) <5 Wood Units (WU) and pulmonary arterial wedge pressure (PAWP) <15 mm Hg. Individuals with a PVR ≥2 WU at baseline (higher PVR group) were older, more symptomatic, with a higher baseline systemic vascular resistance (SVR) than the lower PVR group (all p<0.0001). Individuals with a higher PVR experienced smaller increases in pulmonary blood flow following fluid challenge (0.3 (0.1, 0.5) vs 2.0 (1.5, 2.8) L/min, p<0.0001). Balloon occlusion led to a more marked fall in SVR (p<0.0001) and a larger increase in systemic blood flow (p=0.024) in the higher PVR group. No difference was observed in PAWP following fluid challenge and/or balloon occlusion between groups; four (8%) patients reached a PAWP ≥18 mm Hg following the addition of fluid challenge to balloon occlusion testing. Conclusions In adults with ASD without overt LV disease, even small rises in PVR may have significant implications on cardiovascular haemodynamics. Fluid challenge may provide additional information to balloon occlusion in this setting. No data are available.

中文翻译：

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房间隔缺损患者的液体挑战和球囊闭塞试验

简介 所有房间隔缺损 (ASD) 患者都需要进行仔细、逐步的评估，以排除肺血管或左心室 (LV) 疾病。液体挑战和球囊闭塞可能会暴露 LV 疾病和毛细血管后肺动脉高压，但它们在评估“可手术”ASD 患者中的作用尚不明确。方法 我们在 2018 年至 2020 年期间在意大利的三个专科中心进行了一项前瞻性研究。选择进行经皮 ASD 封堵的患者在基线和液体挑战、球囊闭塞等情况下接受评估。结果共纳入50例患者（46（38.2、57.8）岁，72%为女性）。所有患者的分流分数 >1.5，肺血管阻力 (PVR) <5 Wood Units (WU) 和肺动脉楔压 (PAWP) <15 mm Hg。基线时 PVR ≥ 2 WU 的个体（较高 PVR 组）年龄更大，症状更严重，基线全身血管阻力 (SVR) 高于较低 PVR 组（所有 p<0.0001）。具有较高 PVR 的个体在液体挑战后肺血流量的增加较小（0.3（0.1，0.5）对 2.0（1.5，2.8）L/min，p<0.0001）。在较高 PVR 组中，球囊闭塞导致 SVR 更显着下降（p<0.0001）和全身血流量更大增加（p=0.024）。组间液体刺激和/或球囊闭塞后的 PAWP 没有观察到差异；4 名 (8%) 患者在球囊闭塞测试中加入液体挑战后达到 PAWP ≥18 mm Hg。结论 在没有明显 LV 疾病的 ASD 成人中，即使 PVR 的小幅上升也可能对心血管血流动力学产生重大影响。在这种情况下，液体挑战可能会为球囊阻塞提供额外的信息。没有可用的数据。