Balloon atrial septostomy as initial therapy in pediatric pulmonary hypertension
Paul J Critser1, Patrick D Evers2, Eimear McGovern3
1Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Balloon atrial septostomy (BAS) offers a safe initial therapy for high-risk pediatric pulmonary hypertension. Early BAS in conjunction with medication shows promise for improving survival in these critical cases.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Pulmonary Hypertension Research
Background:
- Balloon atrial septostomy (BAS) is typically a palliative bridge to lung transplantation for severe pulmonary hypertension.
- High-risk pediatric pulmonary hypertension often presents complex management challenges.
Observation:
- This study evaluated BAS as an initial therapy in 19 high-risk pediatric pulmonary hypertension patients.
- Patients underwent BAS during their initial hospitalization for pulmonary hypertension, with no immediate procedural complications or deaths.
Findings:
- Follow-up revealed a 3-year transplant-free survival rate of 67%.
- 16% of patients died, 16% underwent lung transplantation, and 5% received a reverse Potts shunt.
- Early BAS, combined with pharmacotherapy, demonstrated acceptable safety and efficacy.
Implications:
- Early BAS may be a viable initial treatment strategy for select high-risk pediatric pulmonary hypertension patients.
- This approach warrants further investigation as a potential alternative or adjunct to current management protocols.
- Consideration of early BAS could improve outcomes and bridge patients to definitive therapies.
Abstract:
Balloon atrial septostomy is a palliative procedure currently used to bridge medically refractory pulmonary hypertension patients to lung transplantation. In the current report, we present balloon atrial septostomy as an initial therapy for high-risk pediatric pulmonary hypertension patients at our institution. Nineteen patients with median age of 4.3 years (range 0.1-14.3 years) underwent balloon atrial septostomy during initial admission for pulmonary hypertension. There were no procedural complications or deaths within 24 h of balloon atrial septostomy. Patients were followed for a median of 2.6 years (interquartile range 1.0-4.8 years). Three (16%) patients died, 3 (16%) underwent lung transplantation, and 1 (5%) underwent reverse Potts shunt. Transplant-free survival at 30 days, 1 year, and 3 years was 84%, 76%, and 67% respectively. This single-center experience suggests early-BAS in addition to pharmacotherapy is safe and warrants consideration in high-risk pediatric pulmonary hypertension patients.
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