Short-term efficacy of atrial septostomy in the treatment of idiopathic pulmonary arterial hypertension patients complicating with right heart failure.
- Author:
Xin PAN
1
,
2
;
Email: PANXIN805@163.COM.
;
Cheng WANG
;
Youjun ZHANG
;
Weihua WU
;
Lan MA
;
Weimin SU
;
Weiyi FANG
Author Information
- Publication Type:Journal Article
- MeSH: Adult; Catheterization; Familial Primary Pulmonary Hypertension; surgery; Female; Heart Failure; Heart Septum; surgery; Hemodynamics; Humans; Male; Palliative Care; Retrospective Studies; Ventricular Dysfunction, Right; surgery; Young Adult
- From: Chinese Journal of Cardiology 2015;43(4):319-322
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo evaluate the efficacy of atrial septostomy in idiopathic pulmonary arterial hypertension (IPAH) patients complicating right ventricular failure.
METHODSThis 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.
RESULTSSuccessful 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.
CONCLUSIONSAtrial 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.