The Long and Winding Road of Atrial Septostomy

Sandoval, Julio

doi:10.3390/diagnostics10110971

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Maintenance therapies, bridges to urgent transplantation: • Atrial septostomy in its new form, Atrial Flow Regulator (AFR), a 4-10 mm diameter nitrile implant inserted into the atrial septum to create an artificial opening (shunt) in patients in whom maximal drug therapy, using parenteral prostacyclins, is ineffective [49]. The procedure decompresses the right atrium, reduces symptoms of heart failure, improves exercise capacity, and is an established option for bridging to LTx for patients with severe RV failure [50,55,56]. At the same time, by directing part of the output to the left side, it improves the output of the LV and, in this mechanism, enables it to "train", preparing it to receive a higher volume after LTx.…”

Section: Urgent Lung Transplantation -Criteria Role Of Maintenance Th...mentioning

confidence: 99%

Lung transplantation in patients with pulmonary arterial hypertension: The opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation

et al. 2022

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Pulmonary arterial hypertension is a rare but progressive disease that leads to death. Modern drug treatment slows the progression of the disease and prolongs patients' lives, but often, even maximal treatment with parenteral prostacyclin does not prevent deterioration. In the case of inadequate clinical response to drug treatment, lung transplantation (LTx) should be considered. This article aims to analyze thoroughly indications to refer a patient for consultation with a transplant center, the optimal timing of listing for LTx, contraindications for the procedure, bridging techniques, as well as tests needed before and after transplantation. We outline the technique of the procedure and evaluate psychological aspects of LTx.

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Section: Urgent Lung Transplantation -Criteria Role Of Maintenance Th...mentioning

confidence: 99%

Lung transplantation in patients with pulmonary arterial hypertension: The opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation

et al. 2022

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“…The obtained results support the hypothesis that the earlier the intervention is performed, the better the results obtained in terms of prognostic factors. This method can be called a bridge to transplantation, the use of a new pharmacological method, or obtaining an optimal response to its application [ 25 ].…”

Section: Right-to-left Shuntingmentioning

confidence: 99%

Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Stącel

Latos

Urlik

et al. 2021

JCM

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Despite significant advancements in pharmacological treatment, interventional and surgical options are still viable treatments for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH. Herein, we review the interventional and surgical treatments for PAH. Atrial septostomy and the Potts shunt can be useful bridging tools for lung transplantation (Ltx), which remains the final surgical treatment among patients who are refractory to any other kind of therapy. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the ultimate bridging therapy for patients with severe PAH. More importantly, VA-ECMO plays a crucial role during Ltx and provides necessary left ventricular conditioning during the initial postoperative period. Pulmonary denervation may potentially be a new way to ensure better transplant-free survival among patients with the aforementioned disease. However, high-quality randomized controlled trials are needed. As established, obtaining the Eisenmenger physiology among patients with severe pulmonary hypertension by creating artificial defects is associated with improved survival. However, right-to-left shunting may be harmful after Ltx. Closure of the artificially created defects may carry some risk associated with cardiac surgery, especially among patients with Potts shunts. In conclusion, PAH requires an interdisciplinary approach using pharmacological, interventional, and surgical modalities.

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“…Finally, two interventional methods still searching their optimal place within therapeutic strategy in PH are covered by five papers. An interesting report from the Bakoulev National Medical Research Center of Cardiovascular Surgery in Moscow on a large series of stent-protected atrial septostomies [13] is commented on by Prof Sandoval [14], a global expert in this method from the Instituto Nacional de Cardiologia in Mexico City. Three original contributions deal with chronic thromboembolic pulmonary hypertension (CTEPH).…”

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confidence: 99%