| Objective To analysis the related clinical factors in the development of pulmonary arterial hypertension in congenital heart disease with left-to-right shunting and the relationship between the morphological changes and age of the right heart after transcatheter closure of atrial septal defect.Methods A retrospective study was conducted of data on the clinical information of the patients born with abnormal cardiac channel after the right heart catheterization and percutaneous interventional treatment.The information included gender,age,abnormal cardiac channel size,weight,whether or not with other cardiac anomalies and whether or not PAH occurring.158 ASD patients(age from 3 to 66 years),131 patients with patent ductus arteriosus (age from 0.5 to 62 years)and 156 patients with ventricular septal defect(age from 3 to 40 years)were included.And 91 ASD patients who were divided into 2 groups according to whether or not more than 40 years underwent echocardiographic examination before ASD closure,after 3 days,3 months and 6～12 months of transcatheter closure.Result(1)In the ASD patients,the mean defect size was 26.06±8.37 mm(range 4～48mm).A number of clinical factors were chosen but only increasing septal defect size[odds ratio=1.105 per mm(CI1.046～1.168)]and older age[odds ratio=1.041 per year(CI1.008～1.076)]were positively associated with an unfavourable outcome.And more than 40 years had a particularly bad outlook,with an odds ratio of 4.089:1(CI1.438～11.639).(2)In the PDA patients,the mean size of ductus arteriosus was 13.6±5.06mm(range 4～26mm).The increasing ductus arteriosus size was the high risk clinical factors in the development of PAH[odds ratio=1.364 per mm (CI1.190～1.563)].While the lower weight had a good outlook,with an odds ratio of 0.965:1.(3)In the VSD patients,the mean defect size was 10.44±3.13mm(range 2～20mm).The increasing septal defect size was equally positively associated with an unfavourable outcome[odds ratio=1.142 per mm(CI1.011～1.289)].(4)The mean septal defect size was 25.42±8.63mm in the＜40-year-old group with ASD(n=76).And it was 29.33±7.99mm in the group of more than 40 years(n=15).There was no significant difference of the mean septal defect size between the two groups(P＞0.05).But PAH events were more prevalent in the group of more than 40 years than the other group(73.33%vs 38.16%,P＜0.05). Of the two groups,the RVEDD and RADt were significantly decreased after ASD closure(P＜0.001).In the＜40-year-old group,the RVEDD continuously decrease from 3 days to 3 months follow-up(P＜0.05).But no remarkable difference of it was found during 3 to 12 months follow-up.And the RADt significantly decrease more during 6～12months follow-up than 3 days after ASD closure(P＜0.05).But the RVEDD and RADt of the more than 40 years group didn't decrease further from 3 days to 12 months after ASD closure(P＞0.05).Conclusions The increasing abnormal cardiac channel size was the primary clinical factor in the development of PAH in patients with congenital cardiac disease with left-to-right shunting.And the older age was another predictor of bad prognosis in ASD patients.After ASD transcatheter occlusion, the enlarged right heart had significantly resumed,but it didn't continuously decrease further from 3 to 12 months follow-up in the≥40-year-old group.
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