title: [Short-term efficacy of atrial septostomy in the treatment of idiopathic pulmonary arterial hypertension patients complicating with right heart failure].
abstract: OBJECTIVE
  To evaluate the efficacy of atrial septostomy in idiopathic pulmonary arterial hypertension (IPAH) patients complicating right ventricular failure.
  
  
  METHODS
  This retrospective analysis included 5 IPAH patients (3 males, (29.3±15.2) years old) with right ventricular failure which were refractory to conventional and target-specific medication in Shanghai Chest Hospital from March to July 2014. Graded balloon dilation septostomy procedures were performed in all 5 patients.
  
  
  RESULTS
  Successful atrial septostomy was achieved in 5 attempts with no procedure-related complications. Immediately post procedure, the mean systemic oxygen saturation decreased from (98.0±1.8)% to (86.4±3.2)% (P = 0.002), while the mean right atrial pressure decreased from (18.9±1.7) mmHg (1 mmHg = 0.133 kPa) to (16.0±1.3) mmHg (P = 0.039) and the mean cardiac index increased from (2.1±0.3) L · min(-1) · m(-2) to (2.7±0.5) L · min(-1) · m(-2) (P = 0.029). Mean follow-up was (6.2 ±1.8) months. Cardiac functional class (WHO) was 3 in 3 patients and 4 in 2 patients before the procedure, and increased 1 class in all patients during follow-up (P = 0.062). Exercise endurance (6-min walk test) also improved from (289.2±16.9) m to (320.4±19.6) m (P = 0.019), while B-type natriuretic peptide (BNP) level declined from (550.0±35.7) ng/L to (218.0±36.2) ng/L (P < 0.001). Except one patient developed spontaneous closure of created defect, right to left shunt at atrial septal level was evidenced by echocardiography during follow-up in the rest 4 patients.
  
  
  CONCLUSIONS
  Atrial septostomy is safe and can improve hemodynamics and heart function in selected IPAH patients with right heart failure. Atrial septostomy can be used as a palliative treatment for IPAH and further study is warranted to evaluate the long-term efficacy of this procedure.
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China; Email: panxin805@163.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Pan
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.forename: Youjun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Weihua
authors.initials: W
authors.lastname: Wu
authors.forename: Lan
authors.initials: L
authors.lastname: Ma
authors.forename: Weimin
authors.initials: W
authors.lastname: Su
authors.forename: Weiyi
authors.initials: W
authors.lastname: Fang
mesh_terms: D000328:Adult; D002404:Catheterization; D065627:Familial Primary Pulmonary Hypertension / Q000601:surgery*; D005260:Female; D006333:Heart Failure; D006346:Heart Septum / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010166:Palliative Care; D012189:Retrospective Studies; D018497:Ventricular Dysfunction, Right / Q000601:surgery*; D055815:Young Adult