Use of Atrial Septostomy to Treat Severe Pulmonary Arterial Hypertension in Adults

Martín, Maite Velázquez; Gonzalez‐Trevilla, Agustín Albarrán; López-Guarch, Carmen Jiménez; Tejada, Julio García; Asenjo, Roberto Martín; Escribano, Pilar

doi:10.1016/j.rec.2015.09.006

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…The most frequent early complication was pulmonary hypertensive crisis that led to lethal outcomes in three patients. We did not observe any clinically relevant arrhythmias reported by others [10,16,23]. It is also known that AS does not stop the progression of the pulmonary vascular disease, and it is this progression that has caused 77% of lethal outcomes during the follow-up in our patient population.…”

Section: Discussioncontrasting

confidence: 42%

“…However, this technique cannot be considered to be a well-established procedure because of controversial results and relatively small clinical experience. Experience with stent fenestratration of the atrial septum is very limited and does not exceed 15 interventions at one particular institution [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ] ( Table 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Atrioseptostomy with Stenting in Patients with Pulmonary Arterial Hypertension from a Large Single-Institution Cohort

et al. 2020

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The aim of this study was to analyze results of stenting atrioseptostomy in patients with pulmonary arterial hypertension and a different level of risk for one-year mortality that is not well described. Patients that underwent atrioseptostomy with stenting were retrospectively divided in two groups: “intermediate” (n = 55) or “high” risk (n = 13), according to the 2015 ESC/ESR guideline. Results of atrioseptostomy were assessed during hospital period and at follow-up. Patients from “intermediate” risk group demonstrated lower mortality rate (10/55, vs. 6/13) during the course of the study period, as well as higher freedom from lung transplantation or Potts shunt. At discharge, patients of both groups presented improvement in functional class and mobility. Patients from “intermediate” risk group showed longer 6-min walking distance, and lower levels of brain natriuretic peptide. At the latest follow-up, stable position and full patency of stents with right-to-left or bidirectional shunt at atrial level and absence of syncope was confirmed in patients of both groups. Patients from the “intermediate” risk group demonstrated higher functional class, better performance of walking test, and lower levels of brain natriuretic peptide. Stenting atrioseptostomy reliably secured interatrial communication and improved clinical condition in patients with idiopathic pulmonary arterial hypertension. Mid-term results were better in “intermediate” risk group.

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Section: Discussioncontrasting

confidence: 42%

Section: Introductionmentioning

confidence: 99%

Outcomes of Atrioseptostomy with Stenting in Patients with Pulmonary Arterial Hypertension from a Large Single-Institution Cohort

et al. 2020

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“…Transseptal puncture is performed under a mixed fluoroscopic and echocardiographic guidance (either transesophageal or intracardiac), and then a wire is advanced into the left superior pulmonary vein and a catheter is advanced into the left atrium. Graded balloon inflation is then performed until one of the following parameters is reached: LVEDP >18 mmHg, arterial oxygen saturation (SaO 2 ) <80% and/or a decrease of 10%, or the largest balloon (16 mm) is used 15,16 …”

Section: Balloon Atrial Septostomymentioning

confidence: 99%

The evolving role of interventional cardiology in the treatment of pulmonary hypertension

Gurevich

Prins

2020

Cathet Cardio Intervent

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Pulmonary hypertension (PH) is a heterogeneous group of diseases defined by a mean pulmonary arterial pressure greater than 20 mmHg. Clinically, PH is classified into five groups and the group of PH generally defines the cause of PH and the therapeutic options. Currently, medical therapies that target the prostacyclin, endothelin, and nitric oxide pathways are used in pulmonary arterial hypertension and chronic thromboembolic PH (CTEPH) patients. Moreover, surgery can improve outcomes in PH as pulmonary thromboendarterectomy can be curative for CTEPH and lung transplantation is used for end‐stage PH. Despite these diverse treatment options, PH patients continue to have high symptom burden and poor long‐term outcomes. However, advances in percutaneous technology are opening new avenues for the management of PH. In this review, we discuss the available data supporting the use of four interventional procedures: balloon atrial septostomy, transcatheter Potts shunt, balloon pulmonary angioplasty, and pulmonary artery denervation for the treatment of PH. These procedures provide hemodynamic and functional improvements in PH patients, but they come with their own unique risk profiles. Hopefully, these procedures will continue to be refined and thereby provide a venue for interventional cardiology to safely and effectively improve outcomes for PH moving forward.

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“…Atrial septostomy is a percutaneous procedure, by which a right-to-left shunt is created in the atrial septum, allowing decompression of the right side of the heart [45]. Several studies have shown that in the right candidates, atrial septostomy may improve symptoms, haemodynamics and potentially survival in patients with PAH [46][47][48][49][50] (table 2). SANDOVAL et al [42] reported an improvement in functional class, 6-min walking distance (6MWD) and haemodynamic parameters (cardiac index and right ventricular pressure) following atrial septostomy in PAH patients.…”

Section: Invasive Palliative Therapiesmentioning

confidence: 99%

Palliative care in pulmonary arterial hypertension: an underutilised treatment

et al. 2018

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@ERSpublications Palliative care remains an underutilised treatment option in PAH. This article attempts to highlight its importance in the management of PAH and highlight the barriers faced by both physicians and patients in seeking palliative care.ABSTRACT Pulmonary arterial hypertension (PAH) is a condition characterised by increased pulmonary vascular resistance which can lead to right heart failure and premature death. It imposes a significant burden on patients' lives, affecting their physical, emotional and social wellbeing. Pharmacological therapies are the mainstay of treatment; while they are not curative, they can alleviate patient suffering, improve quality of life and delay disease progression. Despite these therapies, disease progresses in a significant number of patients, who are faced with the debilitating symptoms of PAH and treatment adverse effects. Palliative care is focused on providing relief from symptoms caused by a chronic illness. Palliative care aims to improve the health-related quality of life for patients and families, and although it is deemed appropriate at any stage of disease, it is most helpful when explored early in the course of disease. Importantly, palliative care can be provided in concert with pharmacological treatment. Despite its potential benefits, palliative care is frequently underutilised. There is a paucity of clinical studies testing the impact of palliative care in PAH which prompted us to summarise the available evidence, recognise obstacles in its utilisation and identify areas for future research.

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Use of Atrial Septostomy to Treat Severe Pulmonary Arterial Hypertension in Adults

Cited by 5 publications

References 5 publications

Outcomes of Atrioseptostomy with Stenting in Patients with Pulmonary Arterial Hypertension from a Large Single-Institution Cohort

Outcomes of Atrioseptostomy with Stenting in Patients with Pulmonary Arterial Hypertension from a Large Single-Institution Cohort

The evolving role of interventional cardiology in the treatment of pulmonary hypertension

Palliative care in pulmonary arterial hypertension: an underutilised treatment

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