Laboratory data showed an elevated brain natriuretic peptide (BNP) of 621 pg/mL, and a preoperative right heart catheter examination revealed severe PH, presumably associated with ASD, with a mean PAP of 39 mmHg, a high pulmonary blood flow to systemic blood flow ratio (Qp/Qs) of 2.7, and high pulmonary vascular resistance (PVR) 3.5 Wood units. Here, NPPB is linked to atrial septal defect.