Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension. A therapeutic alternative for patients nonresponsive to vasodilator treatment.
OBJECTIVE
We sought to investigate the acute hemodynamic effects of graded balloon dilation atrial septostomy (BDAS) and to define the long-term impact of this procedure on New York Heart Association functional class and survival in adult patients with primary pulmonary hypertension (PPH).


BACKGROUND
Current treatment strategies for patients with severe and refractory PPH are limited by either technical difficulties and high mortality or cost.


METHODS
We studied 15 patients with severe PPH. BDAS was successfully performed in all patients by crossing the interatrial septum with a Brockenbrough needle, followed by progressive dilation of the orifice with a Mansfield balloon in a hemodynamically controlled, step-by-step manner.


RESULTS
BDAS caused an immediate significant fall in right ventricular end-diastolic pressure and in systemic arterial oxygen saturation and an increase in cardiac index. One patient died, and 14 survived the procedure and significantly improved their mean functional class (from 3.57 +/- 0.6 to 2.07 +/- 0.3 [mean +/- SD], p < 0.001). Exercise endurance (6-min test) also improved from 107 +/- 127 to 217 +/- 108 m (p < 0.001). Because of spontaneous closure, BDAS was repeated in four patients. The survival rate among patients who survived the procedure was 92% at 1, 2 and 3 years, which is better than that for historical control PPH patients (73%, 59% and 52%, respectively).


CONCLUSIONS
With careful monitoring, BDAS is a safe and useful palliative treatment for selected patients with severe PPH.
Sandoval
J
J
Cardiopulmonary Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico. sandoval@compuserve.com.mx
Gaspar
J
J
Pulido
T
T
Bautista
E
E
Martínez-Guerra
M L
ML
Zeballos
M
M
Palomar
A
A
Gómez
A
A
D000328:Adult; D002302:Cardiac Output / Q000502:physiology; D002404:Catheterization; D002423:Cause of Death; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery*; D006346:Heart Septum / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009339:Needles; D010100:Oxygen / Q000097:blood; D010166:Palliative Care; D010807:Physical Endurance / Q000502:physiology; D012449:Safety; D015996:Survival Rate; D016278:Ventricular Function, Right / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology
D010100:Oxygen