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- NIH: National Institutes of Health
- NYHA: New York Heart Association
- PAH: pulmonary arterial hypertension
- PPH: primary pulmonary hypertension
Despite progress with new drugs to treat pulmonary arterial hypertension (PAH), a proportion of patients still deteriorate despite medical treatment. Atrial septostomy is emerging as an effective palliative treatment associated with notable improvement in symptoms, exercise capacity, and survival. Experience of this approach in the UK is limited and many cardiologists are either unaware of this option or regard it as an experimental procedure. We report the results of the first 12 atrial septostomy procedures performed at our centre in nine patients to palliate severe PAH.
PATIENTS AND METHODS
Between December 1999 and December 2001 nine female patients underwent atrial septostomy. Three patients had PAH associated with scleroderma; six had primary pulmonary hypertension (PPH). The symptom leading to consideration of septostomy was exercise syncope in five patients and pre-syncope in the others. Six patients were New York Heart Association (NYHA) functional class IV; the remainder were functional class III.
All patients underwent right heart catheter assessment 0–8 months before septostomy. The catheter data are shown in table 1 together with the probability of survival to two years calculated using the regression equation from the US National Institutes of Health (NIH) primary pulmonary hypertension registry.1
Atrial septostomy was performed in a standard cardiac catheter laboratory under local anaesthetic. A transeptal puncture was performed using a Brockenbrough needle via a long femoral sheath. A guide wire was passed into the left atrium and lodged in a pulmonary vein followed by serial dilation of the interatrial septum using 9, 12, 15, and 18 mm balloon catheters in a stepwise fashion. After each dilation, systemic oxygen saturation was observed for at least five minutes and the defect was considered adequate when oxygen saturation remained between 80–85%. Following the procedure all patients were …