A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension.
OBJECTIVE
A significant number of patients with pulmonary hypertension are resistant to medical therapy. We wanted to evaluate whether the modified technique of stent fenestration of the interatrial septum would be feasible and safe, and offer clinical benefit.


RESULTS
The medical records of all patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension who underwent a stent fenestration of the interatrial septum between 2001 and 2008 were reviewed. In all fifteen patients (12 female, mean age 48.2 +/- 20.5 years) a successful fenestration procedure could be performed. Median follow-up time between diagnosis and fenestration was 2.3 years (range from 0.5 to 18.6 years). Mean event free survival since diagnosis and after septostomy was 9.8 +/- 2.9 and 3.2 +/- 0.8 years, respectively. When one extreme outlier was excluded, the 6 min walk distance improved significantly from 309 +/- 69 m immediately before fenestration to 374 +/- 84 m, 3-4 months after fenestration (n = 8, paired t-test, P = 0.03). No stent occlusion occurred.


CONCLUSIONS
The modified stent fenestration technique is feasible and safe in patients with severe pulmonary hypertension. In a selected group of patients, functional capacity might improve although disease progression continues.
Troost
Els
E
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Delcroix
Marion
M
Gewillig
Marc
M
Van Deyk
Kristien
K
Budts
Werner
W
D000328:Adult; D000368:Aged; D054087:Atrial Septum / Q000503:physiopathology; D006328:Cardiac Catheterization; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017079:Exercise Tolerance; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D020127:Recovery of Function; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking