Potts Shunt and Atrial Septostomy in Pulmonary Hypertension Caused by Left Ventricular Disease

2013 ◽  
Vol 96 (1) ◽  
pp. 317-319 ◽  
Author(s):  
Heiner Latus ◽  
Christian Apitz ◽  
Dorle Schmidt ◽  
Christian Jux ◽  
Matthias Mueller ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Ventricular ◽  
Atrial Septostomy

Atrial septostomy benefits severe pulmonary hypertension patients by increase of left ventricular preload reserve

2012 ◽  
Vol 302 (12) ◽  
pp. H2654-H2662 ◽  
Author(s):  
Yvette Koeken ◽  
Nico H. L. Kuijpers ◽  
Joost Lumens ◽  
Theo Arts ◽  
Tammo Delhaas
Keyword(s):  
Blood Pressure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Oxygen Availability ◽  
Peripheral Tissue ◽  
Severe Pulmonary Hypertension ◽  
Shunt Flow ◽  
Atrial Septostomy ◽  
Left Ventricular Preload

At present, it is unknown why patients suffering from severe pulmonary hypertension (PH) benefit from atrial septostomy (AS). Suggested mechanisms include enhanced filling of the left ventricle, reduction of right ventricular preload, increased oxygen availability in the peripheral tissue, or a combination. A multiscale computational model of the cardiovascular system was used to assess the effects of AS in PH. Our model simulates beat-to-beat dynamics of the four cardiac chambers with valves and the systemic and pulmonary circulations, including an atrial septal defect (ASD). Oxygen saturation was computed for each model compartment. The acute effect of AS on systemic flow and oxygen delivery in PH was assessed by a series of simulations with combinations of different ASD diameters, pulmonary flows, and degrees of PH. In addition, blood pressures at rest and during exercise were compared between circulations with PH before and after AS. If PH did not result in a right atrial pressure exceeding the left one, AS caused a left-to-right shunt flow that resulted in decreased oxygenation and a further increase of right ventricular pump load. Only in the case of severe PH a right-to-left shunt flow occurred during exercise, which improved left ventricular preload reserve and maintained blood pressure but did not improve oxygenation. AS only improves symptoms of right heart failure in patients with severe PH if net right-to-left shunt flow occurs during exercise. This flow enhances left ventricular filling, allows blood pressure maintenance, but does not increase oxygen availability in the peripheral tissue.

Clinical Trials Update

2013 ◽  
Vol 12 (3) ◽  
pp. 118-118
Author(s):  
Fernando Torres
Keyword(s):  
Clinical Trials ◽  
Pulmonary Hypertension ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Ongoing Research

The Clinical Trials Update highlights new and ongoing research trials that are evaluating therapies for PAH. In this issue, Fernando Torres, MD, examines a study on patients with pulmonary hypertension associated with left ventricular systolic dysfunction.

Blade Balloon Atrial Septostomy in Patients With Severe Primary Pulmonary Hypertension

Circulation ◽  
1995 ◽  
Vol 91 (7) ◽  
pp. 2028-2035 ◽  
Author(s):  
Diane Kerstein ◽  
Paul S. Levy ◽  
Daphne T. Hsu ◽  
Allan J. Hordof ◽  
Welton M. Gersony ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Primary Pulmonary Hypertension ◽  
Balloon Atrial Septostomy ◽  
Atrial Septostomy

scholarly journals Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

2021 ◽  
Vol 10 (15) ◽  
pp. 3326
Author(s):  
Tomasz Stącel ◽  
Magdalena Latos ◽  
Maciej Urlik ◽  
Mirosław Nęcki ◽  
Remigiusz Antończyk ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Interdisciplinary Approach ◽  
Left Ventricular ◽  
Free Survival ◽  
Atrial Septostomy ◽  
Surgical Options ◽  
Pulmonary Arterial ◽  
Va Ecmo ◽  
Surgical Treatments

Despite significant advancements in pharmacological treatment, interventional and surgical options are still viable treatments for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH. Herein, we review the interventional and surgical treatments for PAH. Atrial septostomy and the Potts shunt can be useful bridging tools for lung transplantation (Ltx), which remains the final surgical treatment among patients who are refractory to any other kind of therapy. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the ultimate bridging therapy for patients with severe PAH. More importantly, VA-ECMO plays a crucial role during Ltx and provides necessary left ventricular conditioning during the initial postoperative period. Pulmonary denervation may potentially be a new way to ensure better transplant-free survival among patients with the aforementioned disease. However, high-quality randomized controlled trials are needed. As established, obtaining the Eisenmenger physiology among patients with severe pulmonary hypertension by creating artificial defects is associated with improved survival. However, right-to-left shunting may be harmful after Ltx. Closure of the artificially created defects may carry some risk associated with cardiac surgery, especially among patients with Potts shunts. In conclusion, PAH requires an interdisciplinary approach using pharmacological, interventional, and surgical modalities.

Prognostic relevance of sleep apnea syndrome in patients with pulmonary arterial hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Precek ◽  
K Vykoupil ◽  
F Kovacik ◽  
M Hutyra
Keyword(s):  
Pulmonary Hypertension ◽  
Sleep Apnea ◽  
Pulmonary Arterial Hypertension ◽  
General Population ◽  
Arterial Hypertension ◽  
Left Ventricular ◽  
Sleep Study ◽  
Prognostic Relevance ◽  
Obstructive Sleep ◽  
Pulmonary Arterial

Abstract Introduction Sleep disordered breathing (SDB) is a group of ventilatory disorders during sleep which includes obstructive sleep apnea (OSA), central sleep apnea (CSA), and sleep related hypoventilation. In patients with SDB, the prevalence of pulmonary hypertension (PH) ranges from 17% to 52%. While SDB is prevalent in the general population with recent estimates of 20% to 30%, in those with cardiovascular disease, particularly left ventricular failure, there is a higher reported prevalence of 47%. Aims The aims of this study were to determine the prevalence and prognostic relevance of sleep apnea in a cohort of patients with newly diagnosed pulmonary arterial hypertension (ESC/WHO Group 1 pulmonary hypertension). Methods We evaluated prospectively 76 patients with the pulmonary arterial hypertension (mean age 54±16 years; 45% male). All patients underwent right heart catheterisation, clinical assessments, sleep study, standard laboratory testing and evaluation of subjective sleepiness by the Epworth Sleepiness Scale. Sleep test was provided with an ApneaLink Plus, consisting of nasal pressure sensor, respiratory effort band, and pulse oximeter worn on the finger. Subjects previously treated for or diagnosed with SDB were excluded from the study. Results Sleep apnea (SA) – defined as apnea-hypopnea index (AHI) ≥5/h – was found in 59 (77.6%) of the pulmonary arterial hypertension (PAH) patients. Mean AHI in the cohort of PAH patients with SA was 26.1±16.6/h. Mean follow-up was 24 months, during which 15 (19.7%) patients died. Characteristics of parameters related to SA in groups of survivors and deceased are in table 1. From the sleep apnea-related parameters, only time with O2Sat <90% – T90 was significantly associated with mortality (AUC 0.856; 95% CI 0.693 – 1.019; p<0.001). Conclusions The presence of sleep apnea in pulmonary arterial hypertension patients is high. The prevalence of sleep apnea is higher in PAH patients than in the general population. The presence of sleep apnea in patients with PAH was not associated with worse prognosis, but noctural hypoxemia (time with O2Sat <90%) was related to poor prognosis. Sleep apnea in patients with PAH should be screened for systematically. Funding Acknowledgement Type of funding source: None

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