Hipertensi Paru Setelah Penutupan Defek Septum Atrium (ASD): Tinjauan Klinis dan Tantangan di Masa Depan

Atrial septal defect (ASD) is one of the most common congenital heart diseases (CHD), which, if left untreated, may cause pulmonary hypertension (PH) and subsequently worsen clinical outcomes. Defect closure is one of the management strategies for ASD; however, persistent post-closure PH produces challenges with a poorer prognosis. Pulmonary hypertension in ASD is multifactorial, involving pulmonary vascular remodelling from a chronic left-to-right shunt. Numerous studies have consistently identified several key predictors for persistent PH, including advanced age at closure, right and left ventricular dysfunction, atrial fibrillation, poor NYHA functional class (III-IV), and comorbidities such as diabetes mellitus and systemic hypertension. The presence of post-closure PH significantly increases the risk of major adverse cardiovascular and cerebrovascular events, heart failure, and mortality. Consequently, modern management approaches are shifting towards more personalized strategies, such as a "treat-and-repair" approach for high-risk patients and structured lifelong evaluation.