Interatrial shunt for chronic pulmonary hypertension: differential impact of low-flow vs. high-flow shunting

Zierer, Andreas; Melby, Spencer J.; Voeller, Rochus K.; Moon, Marc R.

doi:10.1152/ajpheart.00496.2008

Cited by 23 publications

(11 citation statements)

References 29 publications

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“…Kawaguchi et al reported improved systemic oxygen uptake following interatrial shunting in rats with PHT, but again, the degree of shunting could not be quantified . Our group previously demonstrated in dogs with chronic PHT that low‐flow shunting (15% of CO) could improve RA compliance and CO, whereas high‐flow shunting (29% of CO) reversed those beneficial effects . However, although this controlled shunt model could quantify the shunt flow, it could not determine the crossover point that identifies the shift from the ideal to excess shunting.…”

Section: Discussionmentioning

confidence: 93%

“…Limited studies exist addressing the appropriate degree of shunting that should be produced for different levels of PHT . In 1964, Austen et al found improved hemodynamics and exercise capacity after right‐to‐left shunting in dogs, but their model could not control or quantify the shunt fraction .…”

Section: Discussionmentioning

confidence: 99%

“…Animals were anaesthetized with propofol (5–7 mg/kg, i.v. ), intubated, and ventilated with supplemental inhalational 2–4% isoflurane using a standard protocol as previously described by our laboratory . Pulse oximetry, surface electrocardiogram, and arterial blood gases were monitored throughout the experiment.…”

Section: Methodsmentioning

confidence: 99%

“…Our laboratory previously demonstrate that low‐flow right‐to‐left shunting (15% of CO) consistently improved right atrial (RA) mechanics and systemic perfusion in dogs with chronic pulmonary arterial hypertension (PHT), whereas high‐flow shunting (29% of CO) clearly exceeded the ideal with a drop of oxygen delivery below baseline . However, the model did not allow for the differential determination of the optimal shunt fraction based on the degree of RV pressure overload with regards to hemodynamic performance and oxygen delivery.…”

Section: Introductionmentioning

confidence: 99%

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Impact of differential right‐to‐left shunting on systemic perfusion in pulmonary arterial hypertension

Weimar

Watanabe

Kazui

et al. 2012

Cathet Cardio Intervent

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Objectives This study aimed at identifying the ideal right-to-left shunt-fraction to improve cardiac output (CO) and systemic perfusion in pulmonary arterial hypertension (PHT). Background Atrial septostomy has been a high-risk therapeutical option for symptomatic drug-refractory patients with PHT. Results have been unpredictable due to limited knowledge of the optimal shunt-quantity. Methods In 9 dogs, an 8-mm shunt-prosthesis was inserted between the superior vena cava (SVC) and the left atrium. With pulmonary artery banding, mean (±SEM) systolic right ventricular pressure increased from 37±1 mmHg at baseline to 44±1 mmHg (moderate PHT, P=0.005) and 50±2 mmHg (severe PHT, P<0.001). Shunt-flow was adjusted by total (forcing all flow through the shunt) or partial occlusion of the SVC and partial or total clamping of the shunt. Caval-, shunt- and aortic-flow were measured by ultrasonic flow-probes. Blood gases were drawn from the aortic root and pulmonary artery. Results At severe PHT, a shunt-flow of 11±1% of CO (253±90 mL/min) increased CO significantly by 25% (1.8±0.1 to 2.4±0.2 L/min, P=0.005) causing an increase of systemic oxygen delivery index (DO2I) by 23% (309±23 to 399±32 mL/min/M2, P=0.035). Arterial O2-saturation did not change significantly until a shunt-flow of 18±2% was exceeded, causing a drop from 96±1% to 84±4% (P=0.013). At moderate PHT, CO or DO2I did not improve significantly at any shunt-flow. Conclusions In severe PHT, a shunt-flow of 11% of CO represented the ideal shunt-fraction. Augmentation of CO compensated for declined O2-saturation due to right-to-left shunting and improved DO2I. In moderate PHT, atrial septostomy is less promising.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of differential right‐to‐left shunting on systemic perfusion in pulmonary arterial hypertension

Weimar

Watanabe

Kazui

et al. 2012

Cathet Cardio Intervent

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“…For this reason, Zierer et al [26] had tried to determine the qualitative and quantitative impact of low-flow vs. high-flow shunting. In this study, low-flow shunting (15% of cardiac output) improved RV diastolic compliance by 42% and caused a shift of the RA reservoir-to-conduit ratio toward physiological conditions.…”

Section: Discussionmentioning

confidence: 99%

Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Argiriou¹,

Mikroulis

Sakellaridis³

et al. 2011

J Cardiothorac Surg

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AbtractBackgroundIn right ventricular failure (RVF), an interatrial shunt can relieve symptoms of severe pulmonary hypertension by reducing right ventricular preload and increasing systemic flow. Using a pig model to determine if a pulmonary artery - left atrium shunt (PA-LA) is better than a right atrial - left atrial shunt (RA-LA), we compared the hemodynamic effects and blood gases between the two shunts.MethodsThirty, male Large White pigs weighting in average 21.3 kg ± 0.7 (SEM) were divided into two groups (15 pigs per group): In group 1, banding of the pulmonary artery and a pulmonary artery to left atrium shunt with an 8 mm graft (PA-LA) was performed and in group 2 banding of the pulmonary artery and right atrial to left atrial shunt (RA-LA) with a similar graft was performed. Hemodynamic parameters and blood gases were measured from all cardiac chambers in 10 and 20 minutes, half and one hour interval from the baseline (30 min from the banding). Cardiac output and flow of at the left anterior descending artery was also monitored.ResultsIn both groups, a stable RVF was generated. The PA-LA shunt compared to the RA-LA shunt has better hemodynamic performance concerning the decreased right ventricle afterload, the 4 fold higher mean pressure of the shunt, the better flow in left anterior descending artery and the decreased systemic vascular resistance. Favorable to the PA-LA shunt is also the tendency - although not statistically significant - in relation to central venous pressure, left atrial filling and cardiac output.ConclusionThe PA-LA shunt can effectively reverse the catastrophic effects of acute RVF offering better hemodynamic characteristics than an interatrial shunt.

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Atrial Septostomy

Torbicki¹,

Sandoval

2014

The Right Heart

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Interatrial shunt for chronic pulmonary hypertension: differential impact of low-flow vs. high-flow shunting

Cited by 23 publications

References 29 publications

Impact of differential right‐to‐left shunting on systemic perfusion in pulmonary arterial hypertension

Impact of differential right‐to‐left shunting on systemic perfusion in pulmonary arterial hypertension

Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Atrial Septostomy

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