Successful nocturnal continuous positive airway pressure treatment on a patient of obstructive sleep apnea syndrome with post operative pulmonary hypertension in ASD: A case report

In April, 2007, a 74-year-old woman who complained of dyspnea on effort was admitted to our department. Both transthoracic and transesophageal echocardiography revealed atrial septal defect and right cardiac overload. Although it was hard to control cardiac heart failure caused by pulmonary hypertension, cardiac catheterization showed a rather low pulmonary-systemic resistance ratio 0.07, regardless of the high mean pulmonary artery pressure 38 mmHg. The results encouraged us to perform surgical patch closure on the patient. Immediately after the operation, pulmonary artery pressure improved to 30-40 mmHg. After extubation, however, sudden and transient elevation of pulmonary artery pressure was repeatedly observed during sleep time. Since sleep apnea syndrome had something to do with this event, we applied nocturnal non-invasive positive pressure therapy (BilevelPAP), resulting favorably in improvement of pulmonary artery pressure. A full polysomnograph performed later on, showed severe obstructive sleep apnea (OSAS). Thus, this case suggests a way to devise a treatment strategy for pulmonary hypertension.