Document Detail


Atrial septostomy as a bridge to lung transplantation in patients with severe pulmonary hypertension.
MedLine Citation:
PMID:  10498139     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Long waiting times for lung transplantation have limited the survival of patients with advanced pulmonary hypertension. Atrial septostomy has been used in this group of patients in an attempt to prolong survival. We evaluated the results of atrial septostomy in 12 patients using the static graded balloon dilation technique. Between December 1990 and May 1998, 10 women and 2 men (ages 13 to 56 years, mean 37 years) underwent atrial septostomy. Nine patients had primary and 3 patents had secondary pulmonary hypertension. Five patients deteriorated despite long-term intravenous prostacyclin infusions. The atrial septum was crossed with a Brockenbrough needle, followed by an 0.035-J exchange wire and progressively larger catheter balloons for atrial septal dilation, until systemic oxygen saturation decreased 5% to 10%. An atrial septal defect was successfully created in each patient. The mean right atrial pressure decreased from 23 to 18 mm Hg and the mean systemic oxygen saturation decreased from 93% to 85%. The mean cardiac index increased from 1.7 to 2.1 L/min/m2 and the mean systemic oxygen transport increased from 268 to 317 ml/min/m2. Complications occurred in 3 patients: transient hypotension during transesophageal echocardiography, a femoral pseudoaneurysm, and a femoral arteriovenous fistula. After septostomy, 6 patients had clinical improvement (resolution of ascites, edema, and no further episodes of syncope); 5 of these 6 patients underwent lung transplantation a mean of 6.1 months after septostomy. Six patients did not have clinical improvement after septostomy. Atrial septostomy improves the hemodynamic status and may be useful as a bridge to lung transplantation in selected patients with pulmonary hypertension.
Authors:
A Rothman; M S Sklansky; V W Lucas; I A Kashani; R D Shaughnessy; R N Channick; W R Auger; P F Fedullo; C M Smith; J M Kriett; S W Jamieson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  84     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-06     Completed Date:  1999-10-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  682-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Pediatric Cardiology, University of California, San Diego, USA. abrothman@ucsd.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Balloon Dilatation
Echocardiography, Transesophageal
Female
Heart Atria / surgery*
Heart Septum / surgery*
Hemodynamics / physiology
Humans
Hypertension, Pulmonary / diagnosis,  mortality,  surgery*
Lung Transplantation* / physiology
Male
Middle Aged
Oxygen / blood
Palliative Care*
Prognosis
Treatment Outcome
Waiting Lists
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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