Source: Annual Congress 2001 - Disease of the pulmonary circulation
Disease area: Pulmonary vascular diseases

Abstract

INTRODUCTION: Severe pulmonary hypertension is a progressive condition leading to right ventricular failure and death. Atrial septostomy allows decompression of a failing right ventricle with augmentation of systemic blood flow and an increase in the cardiac index (Sandoval et al J Am Coll Cardiol 1998;32:297-304). METHODS: We evaluated the results of atrial septostomy performed in 13 patients at our center. There were 9 female and 4 male patients (mean age 40, 10 had primary and 3 had secondary pulmonary hypertension). 12 patients had deteriorated despite long-term intravenous prostacyclin therapy (6 had arterial satn of <90% on room air). Standard trans-septal puncture techniques allowed positioning of a Cordis Opta balloon across the inter-atrial septum. Graded balloon dilatations (up to 12mm) were performed until systemic oxygen saturation had decreased by 5-10% and cardiac index had improved. RESULTS: Figures represented as mean (SD).(**=p <0.001)

	Cardiac index (l/min/m2)	VO2 Sat %	O2 Sat %
Pre-septostomy	1.66 (0.34)	60 (5.5)	93.5 (3.1)
Post-septostomy	2.07 (0.49) **	50.2 (5.5)	87.7 (4.4) **

Improvement was seen in 11 patients (reduction in oxygen requirement, ascites, oedema, syncope). Improved cardiac index allowed bridging to heart lung transplantation in 5 (mean 3.4 months post-septostomy) and the institution of dialysis in 2 patients. In our cohort 3 patients died at: <24 hrs (unsuccessful septostomy), 5 (arrhythmia) and 7 (self withdrawal from all medical therapy) days post-septostomy respectively. 5 patients continue to survive on medical management alone (mean 4.2 months post-procedure). CONCLUSIONS: Atrial septostomy provides symptom relief and allows bridging to other supportive or more definitive therapies in patients with severe pulmonary hypertension.

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Citations should be made in the following way:
D. K. Satchithananda, J. Pepke-Zaba, N. Doughty, L. M. Shapiro, K. McNeil (Cambridge, United Kingdom). Atrial septostomy in severe pulmonary hypertension - more than just a bridge to heart lung transplantation. Eur Respir J 2001; 16: Suppl. 31, 3513

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