Use of Balloon Atrial Septostomy in Patients With Advanced Pulmonary Arterial Hypertension

Khan, Muhammad Shahzeb; Memon, Muhammad Mustafa; Amin, Emaan; Yamani, Naser; Khan, Safi U.; Figueredo, Vincent M.; Deo, Salil V.; Rich, Jonathan D.; Benza, Raymond L.; Krasuski, Richard A.

doi:10.1016/j.chest.2019.03.003

Cited by 43 publications

(38 citation statements)

References 24 publications

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“…Current literature describes BAS as a ''bridging'' therapy for lung transplantation or a palliative therapy to decrease symptomatology and increase short-term survival due to favorable hemodynamic changes. [3][4][5][6][7] BAS does not appear to have ever been performed as a salvage therapy to allow weaning and decannulation from ECMO.…”

Section: Discussionmentioning

confidence: 99%

“…3 Balloon atrial septostomy (BAS) is a palliative intervention recommended (Class IIb, Level C evidence) in adult patients with PAH awaiting lung transplantation who have failed maximal medical therapy. 3 No recommendations exist on the use of BAS in pediatric patients with severe PAH. Moreover, no literature exists on its use as a palliative therapy to transition off of extracorporeal membrane oxygenation (ECMO) support.…”

mentioning

confidence: 99%

“… 1 Those with severe PAH who fail maximal pharmacologic therapy may be referred for lung transplantation; however, the few who meet transplantation requirements may die waiting, making salvage therapies more critical for these patients. 3 …”

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confidence: 99%

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Palliative balloon atrial septostomy in two pediatric patients with severe pulmonary arterial hypertension requiring extracorporeal membrane oxygenation support

Brackett

Deutsch

Unegbu³

2020

Pulm. circ.

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Pulmonary arterial hypertension is a pernicious disease with a diverse etiology in the pediatric population. Despite the increased availability of drug therapies, pulmonary arterial hypertension continues to cause significant morbidity and mortality. In pediatric patients with severe pulmonary arterial hypertension who have failed medical therapy, a few studies have demonstrated the role of balloon atrial septostomy as a bridge to lung transplantation or a means of improving symptomatology. However, no data exists on the utilization of balloon atrial septostomy as a palliative intervention to wean from extracorporeal membrane oxygenation (ECMO) when all other therapies are exhausted. Here we describe a case series of two pediatric patients with severe pulmonary arterial hypertension, requiring ECMO support, who were successfully weaned from ECMO following balloon atrial septostomy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Palliative balloon atrial septostomy in two pediatric patients with severe pulmonary arterial hypertension requiring extracorporeal membrane oxygenation support

Brackett

Deutsch

Unegbu³

2020

Pulm. circ.

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“…Indications for BAS include syncope, right heart failure, refractory to chronic PAH-targeted therapy, and symptomatic low cardiac output states [ 31 , 32 ]. In the hand of experienced interventionists, it has been a relatively safe procedure with beneficial hemodynamic effect in children and adults with severe PAH [ 33 , 34 , 35 ]. The risk factors associated with high procedural mortality were a mean right atrial pressure > 20 mmHg, resting arterial oxygen saturation < 90%, a left ventricular end-diastolic pressure > 18 mmHg, an indexed pulmonary vascular resistance > 55 Wood units·m 2 and severe right ventricular failure [ 34 , 36 , 37 ].…”

Section: Group 1 Ph ( Table 1 )mentioning

confidence: 99%

Focused Update on Pulmonary Hypertension in Children—Selected Topics of Interest for the Adult Cardiologist

2020

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Pulmonary hypertensive vascular disease (PHVD), and pulmonary hypertension (PH), which is a broader term, are severe conditions associated with high morbidity and mortality at all ages. Treatment guidelines in childhood are widely adopted from adult data and experience, though big differences may exist regarding aetiology, concomitant conditions and presentation. Over the past few years, paediatric aspects have been incorporated into the common guidelines, which currently address both children and adults with pulmonary hypertension (PH). There are multiple facets of PH in the context of cardiac conditions in childhood. Apart from Eisenmenger syndrome (ES), the broad spectrum of congenital heart disease (CHD) comprises PH in failing Fontan physiology, as well as segmental PH. In this review we provide current data and novel aspects on the pathophysiological background and individual management concepts of these conditions. Moreover, we focus on paediatric left heart failure with PH and its challenging issues, including end stage treatment options, such as mechanical support and paediatric transplantation. PH in the context of rare congenital disorders, such as Scimitar Syndrome and sickle cell disease is discussed. Based on current data, we provide an overview on multiple underlying mechanisms of PH involved in these conditions, and different management strategies in children and adulthood. In addition, we summarize the paediatric aspects and the pros and cons of the recently updated definitions of PH. This review provides deeper insights into some challenging conditions of paediatric PH in order to improve current knowledge and care for children and young adults.

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“…Indeed, the early unacceptable procedure-related mortality has been significantly reduced due to a better selection of candidates, technical improvements, and growing experience in dedicated centers [ 2 ]. Despite the use and demonstrated short-term hemodynamic benefits of atrial septostomy in a meta-analysis [ 3 ], its long-term safety, efficacy, and therapeutic role in the setting of advanced PAH were not well defined. A relatively frequent outcome of the procedure, the defect’s spontaneous closure, hindered this knowledge [ 2 ].…”

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confidence: 99%

The Long and Winding Road of Atrial Septostomy

Sandoval

2020

Diagnostics

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Use of Balloon Atrial Septostomy in Patients With Advanced Pulmonary Arterial Hypertension

Cited by 43 publications

References 24 publications

Palliative balloon atrial septostomy in two pediatric patients with severe pulmonary arterial hypertension requiring extracorporeal membrane oxygenation support

Palliative balloon atrial septostomy in two pediatric patients with severe pulmonary arterial hypertension requiring extracorporeal membrane oxygenation support

Focused Update on Pulmonary Hypertension in Children—Selected Topics of Interest for the Adult Cardiologist

The Long and Winding Road of Atrial Septostomy

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