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Atrial septostomy for pulmonary hypertension
J Sandoval1, A Rothman, T Pulido
1Cardiopulmonary Department, Ignacio Chávez National Institute of Cardiology, Mexico City, Mexico. sandoval@compuserve.com.mx
Clinics in Chest Medicine
|October 10, 2001
Summary
Atrial septostomy can improve symptoms and hemodynamics in select severe pulmonary hypertension patients. However, the procedure has high mortality, necessitating careful patient selection and experienced centers to minimize risks.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Interventional Cardiology
Background:
- Severe pulmonary hypertension (PPH) presents significant challenges in patient management.
- Atrial septostomy (AS) is an emerging interventional strategy for advanced PPH.
Purpose of the Study:
- To analyze worldwide experience with atrial septostomy in severe PPH.
- To establish recommendations for patient selection and procedural conduct to improve outcomes.
Main Methods:
- Review of collective worldwide experience with atrial septostomy in PPH patients.
- Identification of predictors for procedure-related death.
- Development of recommendations for patient preparation and procedural management.
Main Results:
- Atrial septostomy can be successfully performed in selected PPH patients, leading to clinical improvement and hemodynamic benefits.
- Procedure-related mortality is high (16%), with predictors of death including elevated mean right atrial pressure (mRAP), high pulmonary vascular resistance index (PVR index), and low predicted survival.
- Optimizing oxygen delivery post-procedure is crucial, potentially requiring blood transfusions or erythropoietin.
Conclusions:
- Atrial septostomy offers palliative benefits for selected severe PPH patients, particularly those with recurrent syncope or right ventricular failure, or as a bridge to transplantation.
- Strict patient selection criteria and performance at experienced centers are essential to mitigate the procedure's significant risks.
- The long-term effects are palliative as the underlying disease process in PPH remains unaffected.