Targeted Drugs, PADN, and Transcatheter Closure for Atrial Septal Defect–Associated Pulmonary Hypertension

Targeted drug therapy and subsequent transcatheter closure are effective in treating atrial septal defects in patients with severe pulmonary arterial hypertension. Nevertheless, despite sufficient pharmacological therapy, many patients do not satisfy the hemodynamic criteria for transcatheter closure under the current guidelines. Here, we report 2 patients with atrial septal defect complicated by pulmonary arterial hypertension, in which successful transcatheter occlusion was achieved through prodromal targeted drug therapy combined with pulmonary artery denervation ablation (PADN). PADN can improve hemodynamic variables in patients who receive adequate targeted drug therapy, which enables them to meet the conditions for performing the occlusion procedure. These cases suggest that PADN is a novel therapeutic approach for patients with congenital heart disease who are in the gray zone of pulmonary arterial hypertension.