Short-term efficacy of atrial septostomy in the treatment of idiopathic pulmonary arterial hypertension patients complicating with right heart failure
10.3760/cma.j.issn.0253-3758.2015.04.008
- VernacularTitle:经皮房间隔造口术治疗特发性肺动脉高压合并右心衰竭效果的初步分析
- Author:
Xin PAN
1
;
Cheng WANG
;
Youjun ZHANG
;
Weihua WU
;
Lan MA
;
Weimin SU
;
Weiyi FANG
Author Information
1. 200030,上海交通大学附属胸科医院心内科
- Keywords:
Hypertension,pulmonary;
Treatment outcome
- From:
Chinese Journal of Cardiology
2015;43(4):319-322
- CountryChina
- Language:Chinese
-
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 · rain-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.
