Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension.
BACKGROUND
Right ventricular (RV) failure is the main cause of death in patients with pulmonary hypertension (PH). Balloon atrial septostomy (BAS) is believed to relieve symptoms of PH by increasing systemic flow and reducing RV preload.


METHODS
Fourteen BAS procedures were performed in 11 patients (5 men and 6 women; mean [+/- SD] age, 33 +/- 12 years) with RV failure in the course of PH that was refractory to conventional treatment. BAS consisted of a puncture of the interatrial septum and subsequent dilatations with balloons of increasing diameter in a step-by-step manner.


RESULTS
After BAS, the mean oxygen saturation of aortic blood decreased (before, 93 +/- 4%; after, 84 +/- 4%; p = 0.001), while mean cardiac index increased (before, 1.54 +/- 0.34 L/min/m(2); after, 1.78 +/- 0.35 L/min/m(2); p = 0.001), resulting in a positive trend for mean systemic oxygen transport (before, 270 +/- 64 mL/min; after, 286 +/- 81 mL/min; p = 0.08). Pulmonary vascular resistance (PVR) slightly increased immediately after the procedure, and this rise inversely correlated with mixed venous blood partial oxygen pressure both before BAS (r = -0.69; p = 0.009) and after BAS (r = -0.64; p = 0.018). Mean functional class improved from 3.2 +/- 0.4 to 2.6 +/- 0.7 (p = 0.03) after 1 month. At follow-up (mean time to follow-up, 8.1 +/- 6.2 months; range, 0.8 to 20.2 months), seven patients died and two underwent lung transplantation. There was no difference in the survival rate compared to that obtained from National Institutes of Health equation. A significant size reduction in the created defect was observed in six patients, requiring repeat BAS procedures in three cases.


CONCLUSIONS
The current BAS technique improves cardiac index and functional class without significant periprocedural complications, except for a transient increase in PVR related to acute desaturation of mixed venous blood. At long-term follow-up, a high incidence of spontaneous decrease in orifice size has been observed.
Kurzyna
Marcin
M
Department of Chest Medicine, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, 01-138 Warsaw, Poland. m.kurzyna@igichp.edu.pl
Dabrowski
Marek
M
Bielecki
Dariusz
D
Fijalkowska
Anna
A
Pruszczyk
Piotr
P
Opolski
Grzegorz
G
Burakowski
Janusz
J
Florczyk
Michal
M
Tomkowski
Witold Z
WZ
Wawrzynska
Liliana
L
Szturmowicz
Monika
M
Torbicki
Adam
A
D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006346:Heart Septum; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000401:mortality / Q000628:therapy*