{
  "abstract": "Background: Data on sinus venosus atrial septal defect (SVASD) closure in patients with coexistent pulmonary arterial hypertension (PAH) are scarce because current guidelines restrict closure to a pulmonary vascular resistance (PVR) of <5 WU.\n\nCase Summary: A 20-year-old woman with severe PAH and a PVR of 12.6 WU underwent successful transcatheter SVASD and partial anomalous pulmonary venous return correction. A small atrial communication was intentionally created as a temporary safety “pop-off,” enabling aggressive postprocedural escalation of PAH therapy.\n\nWhy Beyond the Guidelines?: Patients with severe PAH may still benefit from transcatheter SVASD closure despite guidelines. These patients require highly individualized, nonguideline-directed interventions.\n\nDiscussion: Current guidelines restrict ASD closure to PVR <5 WU, and prior data on closure at higher resistances are largely limited to secundum defects. This successful fenestrated SVASD closure at a baseline PVR of 12.6 WU challenges the utility of relying on a single hemodynamic threshold. Creating a temporary, controlled fenestration provides an essential safety margin, expanding interventional options for high-risk patients who would otherwise be precluded from care.\n\nTake-Home Message: Transcatheter closure of SVASD in patients with severe PAH can effectively reduce the left-to-right shunt and facilitate escalation of PAH-targeted therapies.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Pediatric Cardiology, Washington University School of Medicine, St Louis Children's Hospital, St. Louis, Missouri, USA"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hadeel Allam"
    },
    {
      "affs": [
        0
      ],
      "name": "Eli Fredman"
    },
    {
      "affs": [
        0
      ],
      "name": "Daisuke Kobayashi"
    },
    {
      "affs": [
        0
      ],
      "name": "Manish Aggarwal"
    },
    {
      "affs": [
        0
      ],
      "name": "Ronald Grady"
    },
    {
      "affs": [
        0
      ],
      "name": "David Balzer"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/99qqxsd1tw3y9.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jaccas.2026.110220",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13699077/",
  "id": "99qqxsd1tw3y9",
  "issns": [
    "2666-0849"
  ],
  "landing_url": "https://doi.org/10.1016/j.jaccas.2026.110220",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Beyond the Guidelines"
    ],
    [
      "heading",
      "Congenital Heart Disease"
    ],
    [
      "lcc",
      "RC666-701"
    ],
    [
      "openalex",
      "2740|Cardiovascular and Diving-Related Complications"
    ]
  ],
  "openalex": "W7204959913",
  "pdf_url": null,
  "pmcid": "PMC13699077",
  "pmid": "42709004",
  "published": "2026-09-01",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/99qqxsd1tw3y9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:45Z",
      "native_id": "PMC13699077",
      "source": "pmc",
      "url": "https://doi.org/10.1016/j.jaccas.2026.110220"
    },
    {
      "first_seen": "2026-10-30T13:43:16Z",
      "native_id": "aff48de4dd02479d9a58e25de180e604",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.jaccas.2026.110220"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC666-701",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Transcatheter Sinus Venosus ASD Closure in Severe Pulmonary Hypertension",
  "title_text": "Transcatheter Sinus Venosus ASD Closure in Severe Pulmonary Hypertension",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:16Z",
  "url": "https://research.draconitic.com/paper/99qqxsd1tw3y9",
  "venue": "JACC Case Reports",
  "versions": []
}