Atrial septostomy for severe primary pulmonary hypertension - report on two cases

Atrial septostomy (AS) emerges as a potential therapeutic option in severe primary pulmonary hypertension (PH). AS isa transluminal intervention consisting of perforation of interatrial septum and balloon dilatation. During the procedure an atrial septal defect is created to a diameter permitting right-to-left shunt with the aim of correcting abnormal preload of both ventricles, leading to hemodynamic and functional consequences. We present two patients characterised by severe right ventricular failure. The second patient with rapid clinical deterioration required ,,rescue" rather than elective AS. Despite similar, small sizes of balloons (8 and 6 mm, respectively) used during both procedures, elective AS resulted in a significant and persistent hemodynamic (CI increased from 2.0 to 2.3 1/min/m(2)) and functional improvement while ,,rescue" AS despite short term improvement resulted in an uncontrolled systemic hypoxemia and did not prevent death 28 days after the procedure. Although AS is an invasive and palliative method, it offers persistent functional improvement in patients with primary PH. In view of poor prognosis and limited therapeutic options in Poland, elective AS should be considered as a potentially valuable intervention in patients with primary PH in our country.