Atrial Septostomy in Patients with End-Stage Pulmonary Hypertension. No More Needles but Wires, Energy and Close Anatomical Definition.
Summary of "Atrial Septostomy in Patients with End-Stage Pulmonary Hypertension. No More Needles but Wires, Energy and Close Anatomical Definition."
Objectives: To assess the usefulness of a new approach to atrial septal puncture and septostomy in patients with end-stage pulmonary hypertension. Background: Atrial septostomy in end-stage pulmonary hypertension has high mortality and morbidity rates mainly due to trans-septal catheterization. New approaches to safety during this technical step are expected. Methods: Twelve patients with end-stage pulmonary arterial hypertension (5 males, 7 females, mean age 41, 9 ± 12, 0 years) underwent to balloon atrial septostomy. Intracardiac echography (ICE) was used to localize fossa ovalis while a radiofrequency wire was used to perforate the atrial septum. Then a septostomy was performed by progressive balloon dilatation of atrial septum. Septal perforation was successful at the first attempt in 4 patients and after 5 attempts in a single case, while Bas was successful in all. Results: Pericardial effusion did not develop in any patient. Complications consisted in transient supraventricular tachyarrhythmia, transient cerebral ischemia and severe hypoxemia with ventricular tachycardia in 3 single patients. In-procedure death rate was 0%. Systemic cardiac output increased immediately, while systemic O2 saturation decreased significantly in all. Mean follow-up was 8, 2 ± 3, 8 months. Mortality was 16, 6% (2 patients). NYHA class improved in the rest of patients. Four patients (33, 2%) underwent to pulmonary transplant successfully. Conclusion: This novel approach for trans-septal catheterization has shown very low rate of major complication during atrial septostomy in patients with end-stage pulmonary arterial hypertension. (J Interven Cardiol 2012;**:1-7).
Affiliation
From the IsMeTT, University of Pittsburgh European Center, Palermo, Italy.
Journal Details
This article was published in the following journal.
Name: Journal of interventional cardiology
ISSN: 1540-8183
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22958184
- DOI: http://dx.doi.org/10.1111/j.1540-8183.2012.00759.x
Medical and Biotech [MESH] Definitions
Atrial Flutter
Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES).
Pulmonary Heart Disease
Hypertrophy and dilation of the RIGHT VENTRICLE of the heart that is caused by PULMONARY HYPERTENSION. This condition is often associated with pulmonary parenchymal or vascular diseases, such as CHRONIC OBSTRUCTIVE PULMONARY DISEASE and PULMONARY EMBOLISM.
Epoprostenol
A prostaglandin that is a powerful vasodilator and inhibits platelet aggregation. It is biosynthesized enzymatically from PROSTAGLANDIN ENDOPEROXIDES in human vascular tissue. The sodium salt has been also used to treat primary pulmonary hypertension (HYPERTENSION, PULMONARY).
Hepatopulmonary Syndrome
A syndrome characterized by the clinical triad of advanced chronic liver disease, pulmonary vascular dilatations, and reduced arterial oxygenation (HYPOXEMIA) in the absence of intrinsic cardiopulmonary disease. This syndrome is common in the patients with LIVER CIRRHOSIS or portal hypertension (HYPERTENSION, PORTAL).
Poems Syndrome
A multisystemic disorder characterized by a sensorimotor polyneuropathy (POLYNEUROPATHIES), organomegaly, endocrinopathy, monoclonal gammopathy, and pigmentary skin changes. Other clinical features which may be present include EDEMA; CACHEXIA; microangiopathic glomerulopathy; pulmonary hypertension (HYPERTENSION, PULMONARY); cutaneous necrosis; THROMBOCYTOSIS; and POLYCYTHEMIA. This disorder is frequently associated with osteosclerotic myeloma. (From Adams et al., Principles of Neurology, 6th ed, p1335; Rev Med Interne 1997;18(7):553-62)
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