Atrial Septostomy for Left Ventricular Unloading

2021 ◽  
Vol 14 (24) ◽  
pp. 2708-2710
Author(s):  
Michael Broomé ◽  
Dirk Donker
Keyword(s):  
Left Ventricular ◽  
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.

Balloon atrial septostomy in the intensive care unit under echocardiographic control—nine years experience

1992 ◽  
Vol 2 (2) ◽  
pp. 175-178 ◽  
Author(s):  
Ashok P. Kakadekar ◽  
Alison Hayes ◽  
Eric Rosenthal ◽  
Ian C. Huggon ◽  
Edward J. Baker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Femoral Vein ◽  
Left Ventricular ◽  
Balloon Atrial Septostomy ◽  
Associated Lesions ◽  
Atrial Septostomy ◽  
The Mean

SummaryBetween December 1982 and April 1991, balloon atrial septostomy was performed in the intensive care unit under echocardiographic control in 60 neonates. Of the patients, 58 had complete transposition. Two patients had double outlet right ventricle with a sub-pulmonary ventricular septal defect. Associated lesions included a patent arterial duct in 19 patients, ventricular septal defect in nine, obstruction of the left ventricular outflow tract in six, aortic coarctation in two and tricuspid atresia in one. The mean age at septostomy was four days (range 4 hours - 25 days) and the mean weight 3.19 kg (range 1.17–4.25 kg). In 39 (65%) patients, an infusion of prostaglandin was in progress prior to the septostomy and 22 (37%) were being ventilated. Standard subcostal four-chamber echocardiographic views were used to show the atrial septum and to guide the catheter used for septostomy. Venous access was obtained via the femoral vein in 43 (by percutaneous puncture in 40 and by cutdown in three) and the umbilical vein in 17. Transient atrial arrhythmias were common during the septostomy but no acute hemodynamic disturbances or deaths occurred during the procedure. The size of the atrial septal defect as measured by echocardiography after the septostomy ranged from three to 12 mm in diameter. In only one patient was this inadequate. Three (5%) patients died between two and 10 days after the septostomy, two due to necrotizing enterocolitis and one from persistent hypoxemia. One patient had a cerebral thrombosis and convulsions immediately after the septostomy but made a good neurological recovery. Corrective surgery was performed in 52 (86.6%), two (3.3%) had palliative surgery and two were considered unsuitable for total correction, of whom one has died. One patient died whilst awaiting correction. We conclude that balloon atrial septostomy using echocardiographic guidance can be safely and effectively performed in the intensive care unit.

scholarly journals Left ventricular regression after balloon atrial septostomy in d-transposition of the great arteries

2016 ◽  
Vol 50 (6) ◽  
pp. 1096-1101 ◽  
Author(s):  
Arun Gopalakrishnan ◽  
Bijulal Sasidharan ◽  
Kavassery Mahadevan Krishnamoorthy ◽  
Sivasankaran Sivasubramonian ◽  
Baiju S. Dharan ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Balloon Atrial Septostomy ◽  
Atrial Septostomy

scholarly journals Hemodynamic Adaptation of Heart Failure to Percutaneous Venoarterial Extracorporeal Circulatory Supports

2020 ◽  
pp. 739-757
Author(s):  
P Hála ◽  
O Kittnar
Keyword(s):  
Heart Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
High Volume ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Stroke Work ◽  
Atrial Septostomy ◽  
Active Venting ◽  
Myocardial Oxygen Supply

Extracorporeal life support (ECLS) is a treatment modality that provides prolonged blood circulation, gas exchange and can partially support or fully substitute functions of heart and lungs in patients with severe but potentially reversible cardiopulmonary failure refractory to conventional therapy. Due to high-volume bypass, the extracorporeal flow is interacting with native cardiac output. The pathophysiology of circulation and ECLS support reveals significant effects on arterial pressure waveforms, cardiac hemodynamics, and myocardial perfusion. Moreover, it is still subject of research, whether increasing stroke work caused by the extracorporeal flow is accompanied by adequate myocardial oxygen supply. The left ventricular (LV) pressure-volume mechanics are reflecting perfusion and loading conditions and these changes are dependent on the degree of the extracorporeal blood flow. By increasing the afterload, artificial circulation puts higher demands on heart work with increasing myocardial oxygen consumption. Further, this can lead to LV distention, pulmonary edema, and progression of heart failure. Multiple methods of LV decompression (atrial septostomy, active venting, intra-aortic balloon pump, pulsatility of flow) have been suggested to relieve LV overload but the main risk factors still remain unclear. In this context, it has been recommended to keep the rate of circulatory support as low as possible. Also, utilization of detailed hemodynamic monitoring has been suggested in order to avoid possible harm from excessive extracorporeal flow.

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.

Successful Management of a COVID-19 Positive Infant With Transposition of the Great Arteries

2021 ◽  
pp. 215013512110006
Author(s):  
Tomasz J. Nabialek ◽  
Naga K. Puppala ◽  
Andrew Riordan ◽  
Ram Ramaraj ◽  
Phuoc Duong ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Prostaglandin E1 ◽  
Arterial Switch Operation ◽  
Left Ventricular ◽  
Intact Ventricular Septum ◽  
Successful Management ◽  
Membrane Oxygenation ◽  
Switch Operation ◽  
Atrial Septostomy

A six-week-old infant presented in extremis and was diagnosed with dextro-transposition of the great arteries, intact ventricular septum, features of left ventricular deconditioning, and abnormal coronary arteries. Treatment with prostaglandin E1 and balloon atrial septostomy was insufficient, necessitating extracorporeal membrane oxygenation (ECMO). Severe acute respiratory syndrome coronavirus-2 was detected. The arterial switch operation was delayed by eight days because of COVID-19. Although stable on ECMO, the infant was treated with remdesivir. Extracorporeal membrane oxygenation was not required postoperatively with chest closure on day 2 and extubation on day 5.

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

scholarly journals The hemodynamic effect of different left ventricular unloading techniques during veno-arterial extracorporeal life support: a systematic review and meta-analysis

Perfusion ◽  
2020 ◽  
Vol 35 (7) ◽  
pp. 664-671 ◽  
Author(s):  
Christiaan Lucas Meuwese ◽  
Marloes de Haan ◽  
Peter-Paul Zwetsloot ◽  
Sue Braithwaite ◽  
Faiz Ramjankhan ◽  
...  
Keyword(s):  
Life Support ◽  
Diastolic Pressure ◽  
Extracorporeal Life Support ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Blood Pump ◽  
Pulmonary Capillary ◽  
Atrial Septostomy ◽  
Mean Differences ◽  
Wedge Pressure

Background: Pulmonary edema and left ventricular thrombosis may arise during veno-arterial extracorporeal life support due to an increase in cardiac load. This mechanical stress can be reduced through different left ventricular unloading techniques. We set out to quantitatively summarize the hemodynamic effects of available methods in patients treated with veno-arterial extracorporeal life support. Methods: Literature was systematically searched for studies reporting left ventricular unloading during veno-arterial extracorporeal life support as reflected by changes in left atrial pressure, pulmonary capillary wedge pressure, diastolic pulmonary artery pressure, or left ventricular end-diastolic pressure. For studies including ⩾10 patients per group, changes in these parameters were pooled using (1) standardized mean differences and (2) ratio of means. Assessment of potential bias was performed for all studies. Results: Eight studies met the inclusion criteria. Reported techniques included use of intra-aortic balloon pump (n = 1), micro-axial blood pump (Impella®, n = 2), left ventricular venting (n = 1), and atrial septostomy (n = 4). Overall, left ventricular unloading was associated with a statistically significant reduction in preload parameters (standardized mean differences = −1.05 (95% confidence interval = −1.24 to −0.86) and ratio of means = 0.60 (0.47 to 0.76)). Effect sizes were strongest for micro-axial blood pump and atrial septostomy (standardized mean differences = −1.11 (−1.55 to −0.68) and −1.22 (−1.47 to −0.96), and ratio of means = 0.58 (0.39 to 0.86) and 0.54 (0.36 to 0.83), respectively). Conclusion: Left ventricular unloading was associated with a significant reduction in left ventricular preload parameters in the setting of veno-arterial extracorporeal life support. This effect may be most pronounced for micro-axial blood pump and atrial septostomy.

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