Atrial Septostomy in Treatment of End-Stage Right Heart Failure in Patients With Pulmonary Hypertension
| Autor: | Liliana Wawrzyńska, Witold Tomkowski, Michał Florczyk, Piotr Pruszczyk, Monika Szturmowicz, Marek Dabrowski, Janusz Burakowski, Marcin Kurzyna, Adam Torbicki, Anna Fijałkowska, Dariusz Bielecki, Grzegorz Opolski |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Cardiac Catheterization medicine.medical_specialty Time Factors Hypertension Pulmonary Ventricular Dysfunction Right medicine.medical_treatment Critical Care and Intensive Care Medicine Catheterization Internal medicine Heart Septum medicine Humans Heart Atria Pulmonary Wedge Pressure Atrial septostomy Pulmonary wedge pressure Heart Failure business.industry Oxygen transport Central venous pressure Middle Aged medicine.disease Pulmonary hypertension Heart septum Survival Rate Treatment Outcome medicine.anatomical_structure Heart failure Vascular resistance Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Chest. 131:977-983 |
| ISSN: | 0012-3692 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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