title: Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical experience.
abstract: BACKGROUND
  Patients with severe pulmonary arterial hypertension (PAH) face significant morbidity and death as a consequence of progressive right heart failure. Surgical shunt placement between the left PA and descending aorta (Potts shunt) appears promising for PAH palliation in children; however, surgical mortality is likely to be unacceptably high in adults with PAH.
  
  
  METHODS
  We describe a technique for transcatheter Potts shunt (TPS) creation by fluoroscopically guided retrograde needle perforation of the descending aorta at the site of apposition to the left PA to create a tract for deployment of a covered stent between these vessels. This covered stent-anchored by the vessel walls and surrounding tissue-serves as the shunt.
  
  
  RESULTS
  TPS creation was considered in 7 patients and performed in 4. The procedure was technically successful in 3 patients; 1 patient died during the procedure as a result of uncontrolled hemothorax. One acute survivor, critically ill at the time of TPS creation, later died of comorbidities. The 2 mid-term survivors (follow-up of 10 and 4 months) are well at home, with symptomatic improvement and no late complications. The 3 candidate patients in whom the procedure was not performed died within 1 month of consideration, underscoring the tenuous nature of this population.
  
  
  CONCLUSIONS
  TPS creation is feasible and may offer symptomatic relief to select patients with refractory PAH. Further study of this innovative approach is warranted.
authors: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors: Jesse J
authors: JJ
authors: Esch
authors: Pinak B
authors: PB
authors: Shah
authors: Barbara A
authors: BA
authors: Cockrill
authors: Harrison W
authors: HW
authors: Farber
authors: Michael J
authors: MJ
authors: Landzberg
authors: Mandeep R
authors: MR
authors: Mehra
authors: Mary P
authors: MP
authors: Mullen
authors: Alexander R
authors: AR
authors: Opotowsky
authors: Aaron B
authors: AB
authors: Waxman
authors: James E
authors: JE
authors: Lock
authors: Audrey C
authors: AC
authors: Marshall
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001013:Aorta, Thoracic / Q000601:surgery*; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods