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Atrial Septostomy in Treatment of End-Stage Right Heart Failure in Patients With Pulmonary Hypertension^*

Marcin Kurzyna, MD, PhD; Marek Dbrowski, MD, PhD; Dariusz Bielecki, MD; Anna Fijalkowska, MD, PhD; Piotr Pruszczyk, MD, PhD; Grzegorz Opolski, MD, PhD; Janusz Burakowski, MD, PhD; Michal Florczyk, MD; Witold Z. Tomkowski, MD, PhD, FCCP; Liliana Wawrzyska, MD, PhD; Monika Szturmowicz, MD, PhD, FCCP and Adam Torbicki, MD, PhD

^* From the Department of Chest Medicine (Drs. Kurzyna, Fijalkowska, Florczyk, Wawrzyska, Szturmowicz, and Torbicki), and Intensive Care Unit (Drs. Burakowski and Tomkowski), National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland; the Department of Cardiology (Drs. Dbrowski and Bielecki), Bielanski Hospital, Warsaw, Poland; and the Department of Internal Medicine, Hypertension, and Angiology (Dr. Pruszczyk), and the First Department of Cardiology (Dr. Opolski), Medical University of Warsaw, Warsaw, Poland.

Correspondence to: Marcin Kurzyna, MD, PhD, Department of Chest Medicine, National Tuberculosis and Lung Diseases Research Institute, Plocka 26, 01–138 Warsaw, Poland; e-mail: m.kurzyna{at}igichp.edu.pl

Abstract

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/m²; after, 1.78 ± 0.35 L/min/m²; 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.

Key Words: atrial septostomy • interventional cardiology • pulmonary hypertension • survival • treatment

Related Editorial

Atrial Septostomy: Why We Still Need It

Victor Tapson
Chest 2007 131: 947-948. [Full Text] [PDF]

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