Balloon Atrial Septostomy Increases Cardiac Index and May Reduce Mortality among Pulmonary Hypertension Patients Awaiting Lung Transplantation

Abstract

The prognosis for patients with pulmonary hypertension is extremely poor. Predictors of poor prognosis among these patients include a cardiac index less than 2.8 L/m/m2, a mean pulmonary artery pressure higher than 50 mm Hg, a mean right atrial pressure more than 10 mm Hg, and PaO2 less than 70 mm Hg. Balloon atrial septostomy was performed as a palliative procedure in six patients with pulmonary hypertension to limit further deterioration while they awaited lung transplantation. The goal of balloon atrial septostomy was to increase cardiac output while limiting the reduction in systemic oxygen saturation to less than 10% of baseline. This procedure may prove to be a valuable adjunct to reduce morbidity and mortality from right ventricular failure for pulmonary hypertension candidates awaiting lung transplantation.

Atrial septostomy in the treatment of severe pulmonary arterial hypertension

“…9 10 18 In our study the graded balloon dilatation technique was associated with a spontaneous closure rate of 15% compared with 17% reported in the literature. [9][10][11][12][13][14][15] CI measured by both the thermodilution and Fick methods significantly improved after AS. However, CI measured by thermodilution was significantly lower than the calculation based on the Fick method.…”

“…Reports in patients with Eisenmenger's syndrome (an anatomical right-to-left shunt) have found better survival in patients with the same degree of pulmonary hypertension than in those with primary pulmonary hypertension. 7 The initial report of AS in PAH in 1983 8 was followed by several series [9][10][11][12][13][14][15] which showed that AS improves haemodynamics but may be associated with a high post-procedure mortality rate of up to 30%. 11 14 However, experience with AS in severe PAH is still limited, and the optimal time to perform AS in these severely ill patients (if at all) remains to be established.…”

Atrial septostomy for pulmonary arterial hypertension

“…4 Early series from the USA reported high mortality-largely caused by difficulty in achieving accurate control of the size of the atrial shunt. [5][6][7][8][9] Improvements in patient selection together with use of a sequential, balloon dilation technique have improved the safety of the procedure. [10][11][12][13] Recent series show significant improvements in exercise capacity and survival when compared with retrospective controls.…”

Balloon dilation atrial septostomy for advanced pulmonary hypertension in patients on prostanoid therapy

“…Early experience with BDAS was associated with high mortality rates, largely due to difficulty in controlling the size of the shunt, thereby leading to severe hypoxemia and acute left ventricular failure . More recent series have shown decreased procedural and one‐month mortality rates, due largely to improved patient selection and the advent of graded balloon septostomy .…”