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Updated: Jan 31, 2026
Evaluation of Right Ventricular Function in Experimental Models of Pulmonary Arterial Hypertension
Published on: June 27, 2025
Potts Shunt Improves Right Ventricular Function and Coupling With Pulmonary Circulation in Children With
Manish Aggarwal1, R Mark Grady2, Swati Choudhry1
1Department of Pediatrics, Baylor College of Medicine, Houston, TX (M.A., S.C.).
Insights
The Potts shunt procedure improved survival and functional status in pediatric patients with severe pulmonary arterial hypertension by enhancing right ventricular function and its coupling with the pulmonary artery.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Pulmonary Hypertension Research
Background:
- Pulmonary arterial hypertension (PAH) in children is a severe condition with limited treatment options.
- Right ventricular (RV) dysfunction significantly impacts prognosis in pediatric PAH.
- The Potts shunt is a novel surgical intervention for PAH, but its effects on RV function and survival are not well-documented.
Purpose of the Study:
- To assess the impact of the Potts shunt on RV function, RV-PA coupling, and survival in pediatric patients with suprasystemic PAH.
- To evaluate changes in pulmonary hemodynamics and functional status post-Potts shunt placement.
Main Methods:
- Retrospective analysis of 12 pediatric patients undergoing elective Potts shunt for suprasystemic PAH.
- Echocardiographic assessment of RV function, RV work, and RV-PA coupling before and after the procedure.
- Evaluation of pulmonary hemodynamics, functional class, and survival rates.
Main Results:
- Eight of the 11 eligible patients survived for a median of 27 months post-shunt.
- Survivors showed significant improvement in WHO functional class and reduced need for pulmonary vasodilators.
- Post-shunt, improvements were observed in RV systolic function, decreased RV afterload and work, and enhanced RV-PA coupling.
Conclusions:
- The Potts shunt serves as a viable option for improving functional status and mid-term survival in pediatric patients with suprasystemic PAH.
- The procedure positively impacts RV systolic function and RV-PA coupling, crucial factors for managing this condition.
Background:
Pulmonary arterial hypertension is a progressive disease with poor outcomes in children. Right ventricular (RV) function is the most important determinant of the prognosis. Novel application of Potts shunt between left pulmonary artery and descending aorta has been introduced in an attempt to improve the survival. However, the effect of Potts shunt creation on RV function, RV-PA coupling, and survival has not been studied.
Methods And Results:
We evaluated the first 12 consecutive pediatric patients (9 male, median age 11.2 years and weight 32.8 kg) who underwent elective Potts shunt placement for suprasystemic pulmonary arterial hypertension between 2013 and 2017 with echocardiographic indices of RV function, RV work, RV-PA coupling, and pulmonary hemodynamics. Of 12 patients, 1 was excluded because of insufficient preshunt data, 2 died, 1 required lung transplant, and 8 survived for a median of 27 months postshunt. In survivors, WHO functional class significantly ( P=0.01) improved and the majority (5 of 8) came off pulmonary vasodilators at the most recent follow-up. Postshunt RV systolic function improved ( P=0.03), RV afterload decreased ( P <0.01), RV work decreased ( P=0.02), and RV-proximal PA coupling improved ( P<0.01).
Conclusions:
This proof of concept study shows that Potts shunt allows improvement in functional status and mid-term transplant-free survival in the majority of the recipients by improvement in RV systolic function and RV-PA coupling in children with suprasystemic pulmonary arterial hypertension.
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