Advertisement

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME

About the Journal
Editorial Board & Staff

About JACC CME
Hardware/Software Requirements
Contact Us
Policy on Privacy and Confidentiality
Copyright Information

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

ACC.org
Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions

Click here for more guidelines.
2009 Focused Updates: ACC/AHA Guidelines for STEMI and ACC/AHA/SCAI Guidelines for PCI
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
ACC 2009 Advocacy Position Statement: Principles for Comparative Effectiveness Research
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 1998; 32:297-304
© 1998 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Sandoval, J.
Right arrow Articles by Gómez, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sandoval, J.
Right arrow Articles by Gómez, A.

CLINICAL STUDIES

Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension

A therapeutic alternative for patients nonresponsive to vasodilator treatment

Julio Sandoval, MD, FACCa, Jorge Gaspar, MD, FACCa, Tomás Pulido, MDa, Edgar Bautista, MDa, Maria Luisa Martínez-Guerra, MDa, Marco Zeballos, MDa, Andrés Palomar, MDa and Arturo Gómez, MDa

a Cardiopulmonary and the Interventional Catheterization Laboratory Departments, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico

Manuscript received January 13, 1998; revised manuscript received April 16, 1998, accepted April 27, 1998.

Address for correspondence: Dr. Julio Sandoval, Cardiopulmonary Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Tlalpan 14080, Mexico D.F., Mexico
sandoval{at}compuserve.com.mx

Objectives. We sought to investigate the acute hemodynamic effects of graded balloon dilation atrial septostomy (BDAS) and to define the long-term impact of this procedure on New York Heart Association functional class and survival in adult patients with primary pulmonary hypertension (PPH).

Background. Current treatment strategies for patients with severe and refractory PPH are limited by either technical difficulties and high mortality or cost.

Methods. We studied 15 patients with severe PPH. BDAS was successfully performed in all patients by crossing the interatrial septum with a Brockenbrough needle, followed by progressive dilation of the orifice with a Mansfield balloon in a hemodynamically controlled, step-by-step manner.

Results. BDAS caused an immediate significant fall in right ventricular end-diastolic pressure and in systemic arterial oxygen saturation and an increase in cardiac index. One patient died, and 14 survived the procedure and significantly improved their mean functional class (from 3.57 ± 0.6 to 2.07 ± 0.3 [mean ± SD], p < 0.001). Exercise endurance (6-min test) also improved from 107 ± 127 to 217 ± 108 m (p < 0.001). Because of spontaneous closure, BDAS was repeated in four patients. The survival rate among patients who survived the procedure was 92% at 1, 2 and 3 years, which is better than that for historical control PPH patients (73%, 59% and 52%, respectively).

Conclusions. With careful monitoring, BDAS is a safe and useful palliative treatment for selected patients with severe PPH.

Abbreviations and Acronyms
  BBAS = blade-balloon atrial septostomy
  BDAS = balloon dilation atrial septostomy
  CI = cardiac index
  LVEDP = left ventricular end-diastolic pressure
  PAP = pulmonary artery pressure
  PPH = primary pulmonary hypertension
  PVRI = pulmonary vascular resistance index
  RAP = right atrial pressure
  RVEDP = right ventricular end-diastolic pressure
  SaO2% = systemic arterial oxygen saturation




This article has been cited by other articles:


Home page
 Eur Heart JHome page
Authors/Task Force Members, N. Galie, M. M. Hoeper, M. Humbert, A. Torbicki, J.-L. Vachiery, J. A. Barbera, M. Beghetti, P. Corris, S. Gaine, et al.
Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)
Eur. Heart J., October 2, 2009; 30(20): 2493 - 2537.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. M. Keogh, E. Mayer, R. L. Benza, P. Corris, P. G. Dartevelle, A. E. Frost, N. H. Kim, I. M. Lang, J. Pepke-Zaba, and J. Sandoval
Interventional and surgical modalities of treatment in pulmonary hypertension.
J. Am. Coll. Cardiol., June 30, 2009; 54(1 Suppl): S67 - S77.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. J. Barst, J. S. R. Gibbs, H. A. Ghofrani, M. M. Hoeper, V. V. McLaughlin, L. J. Rubin, O. Sitbon, V. F. Tapson, and N. Galie
Updated evidence-based treatment algorithm in pulmonary arterial hypertension.
J. Am. Coll. Cardiol., June 30, 2009; 54(1 Suppl): S78 - S84.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
V. V. McLaughlin, S. L. Archer, D. B. Badesch, R. J. Barst, H. W. Farber, J. R. Lindner, M. A. Mathier, M. D. McGoon, M. H. Park, R. S. Rosenson, et al.
ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association Developed in Collaboration With the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association
J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1573 - 1619.
[Full Text] [PDF]

Home page
 CirculationHome page
Writing Committee Members, V. V. McLaughlin, S. L. Archer, D. B. Badesch, R. J. Barst, H. W. Farber, J. R. Lindner, M. A. Mathier, M. D. McGoon, M. H. Park, et al.
ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: Developed in Collaboration With the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association
Circulation, April 28, 2009; 119(16): 2250 - 2294.
[Full Text] [PDF]

Home page
 Mayo Clin Proc.Home page
M. D. McGoon and G. C. Kane
Pulmonary Hypertension: Diagnosis and Management
Mayo Clin. Proc., February 1, 2009; 84(2): 191 - 207.
[Abstract] [Full Text] [PDF]

Home page
 Ther Adv Respir DisHome page
K. Boutet, D. Montani, X. Jais, A. Yaici, O. Sitbon, G. Simonneau, and M. Humbert
Review: Therapeutic advances in pulmonary arterial hypertension
Therapeutic Advances in Respiratory Disease, August 1, 2008; 2(4): 249 - 265.
[Abstract] [PDF]

Home page
 CirculationHome page
F. Haddad, R. Doyle, D. J. Murphy, and S. A. Hunt
Right Ventricular Function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Importance, and Management of Right Ventricular Failure
Circulation, April 1, 2008; 117(13): 1717 - 1731.
[Full Text] [PDF]

Home page
 HeartHome page
National Pulmonary Hypertension Centres of the UK
Consensus statement on the management of pulmonary hypertension in clinical practice in the UK and Ireland
Heart, March 1, 2008; 94(Suppl_1): i1 - i41.
[Full Text] [PDF]

Home page
 ThoraxHome page
National Pulmonary Hypertension Centres of the UK
Consensus statement on the management of pulmonary hypertension in clinical practice in the UK and Ireland
Thorax, March 1, 2008; 63(Suppl_2): ii1 - ii41.
[Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
M. Kurzyna and A. Torbicki
Neurohormonal modulation in right ventricular failure
Eur. Heart J. Suppl., December 1, 2007; 9(suppl_H): H35 - H40.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
A. Ciarka, J.-L. Vachiery, A. Houssiere, M. Gujic, E. Stoupel, S. Velez-Roa, R. Naeije, and P. van de Borne
Atrial Septostomy Decreases Sympathetic Overactivity in Pulmonary Arterial Hypertension
Chest, June 1, 2007; 131(6): 1831 - 1837.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
V. Tapson
Atrial Septostomy: Why We Still Need It
Chest, April 1, 2007; 131(4): 947 - 948.
[Full Text] [PDF]

Home page
 ChestHome page
M. Kurzyna, M. Dabrowski, D. Bielecki, A. Fijalkowska, P. Pruszczyk, G. Opolski, J. Burakowski, M. Florczyk, W. Z. Tomkowski, L. Wawrzynska, et al.
Atrial Septostomy in Treatment of End-Stage Right Heart Failure in Patients With Pulmonary Hypertension
Chest, April 1, 2007; 131(4): 977 - 983.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
D J Fox and R S Khattar
Pulmonary arterial hypertension: classification, diagnosis and contemporary management
Postgrad. Med. J., November 1, 2006; 82(973): 717 - 722.
[Full Text] [PDF]

Home page
 CirculationHome page
V. V. McLaughlin and M. D. McGoon
Pulmonary Arterial Hypertension
Circulation, September 26, 2006; 114(13): 1417 - 1431.
[Full Text] [PDF]

Home page
 HeartHome page
A Micheletti, A A Hislop, A Lammers, P Bonhoeffer, G Derrick, P Rees, and S G Haworth
Role of atrial septostomy in the treatment of children with pulmonary arterial hypertension
Heart, July 1, 2006; 92(7): 969 - 972.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
L. J. Rubin
Pulmonary arterial hypertension.
Proceedings of the ATS, January 1, 2006; 3(1): 111 - 115.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
L. J. Rubin and D. B. Badesch
Evaluation and Management of the Patient with Pulmonary Arterial Hypertension
Ann Intern Med, August 16, 2005; 143(4): 282 - 292.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
A Rashid and D Ivy
Severe paediatric pulmonary hypertension: new management strategies
Arch. Dis. Child., January 1, 2005; 90(1): 92 - 98.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
Task Force members, N. Galie, A. Torbicki, R. Barst, P. Dartevelle, S. Haworth, T. Higenbottam, H. Olschewski, A. Peacock, G. Pietra, et al.
Guidelines on diagnosis and treatment of pulmonary arterial hypertension: The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology
Eur. Heart J., December 2, 2004; 25(24): 2243 - 2278.
[Full Text] [PDF]

Home page
 NEJMHome page
M. Humbert, O. Sitbon, and G. Simonneau
Treatment of Pulmonary Arterial Hypertension
N. Engl. J. Med., September 30, 2004; 351(14): 1425 - 1436.
[Full Text] [PDF]

Home page
 ChestHome page
R. L. Doyle, D. McCrory, R. N. Channick, G. Simonneau, and J. Conte
Surgical Treatments/Interventions for Pulmonary Arterial Hypertension: ACCP Evidence-Based Clinical Practice Guidelines
Chest, July 1, 2004; 126(1_suppl): 63S - 71S.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
W. Klepetko, E. Mayer, J. Sandoval, E. P. Trulock, J.-L. Vachiery, P. Dartevelle, J. Pepke-Zaba, S. W. Jamieson, I. Lang, and P. Corris
Interventional and surgical modalities of treatment for pulmonary arterial hypertension
J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 73S - 80S.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
N. Galie, W. Seeger, R. Naeije, G. Simonneau, and L. J. Rubin
Comparative analysis of clinical trials and evidence-based treatment algorithm in pulmonary arterial hypertension
J. Am. Coll. Cardiol., June 16, 2004; 43(12_Suppl_S): 81S - 88S.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
R J Allcock, J J O'Sullivan, and P A Corris
Atrial septostomy for pulmonary arterial hypertension
Heart, November 1, 2003; 89(11): 1344 - 1347.
[Full Text] [PDF]

Home page
 ThoraxHome page
F Reichenberger, J Pepke-Zaba, K McNeil, J Parameshwar, and L M Shapiro
Atrial septostomy in the treatment of severe pulmonary arterial hypertension
Thorax, September 1, 2003; 58(9): 797 - 800.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
M. Humbert, O. Sitbon, and G. Simonneau
Novel therapeutic perspectives in pulmonary arterial hypertension
Eur. Respir. J., August 1, 2003; 22(2): 193 - 194.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
A. Widlitz and R.J. Barst
Pulmonary arterial hypertension in children
Eur. Respir. J., January 1, 2003; 21(1): 155 - 176.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
N. Galie, A. Manes, and A. Branzi
The new clinical trials on pharmacological treatment in pulmonary arterial hypertension
Eur. Respir. J., October 1, 2002; 20(4): 1037 - 1049.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
R. Schulz, G. Baseler, H.A. Ghofrani, F. Grimminger, H. Olschewski, and W. Seeger
Nocturnal periodic breathing in primary pulmonary hypertension
Eur. Respir. J., April 1, 2002; 19(4): 658 - 663.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
E. Bossone, G. Paciocco, D. Iarussi, A. Agretto, A. Iacono, B. W. Gillespie, and M. Rubenfire
The Prognostic Role of the ECG in Primary Pulmonary Hypertension
Chest, February 1, 2002; 121(2): 513 - 518.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. M. HOEPER, N. GALIE, S. MURALI, H. OLSCHEWSKI, M. RUBENFIRE, I. M. ROBBINS, H. W. FARBER, V. MCLAUGHLIN, S. SHAPIRO, J. PEPKE-ZABA, et al.
Outcome after Cardiopulmonary Resuscitation in Patients with Pulmonary Arterial Hypertension
Am. J. Respir. Crit. Care Med., February 1, 2002; 165(3): 341 - 344.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
E. N. Mendeloff, B. F. Meyers, T. M. Sundt, T. J. Guthrie, S. C. Sweet, M. de la Morena, S. Shapiro, D. T. Balzer, E. P. Trulock, J. P. Lynch, et al.
Lung transplantation for pulmonary vascular disease
Ann. Thorac. Surg., January 1, 2002; 73(1): 209 - 219.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
British Cardiac Society Guidelines and Medical Pra
Recommendations on the management of pulmonary hypertension in clinical practice
Heart, September 1, 2001; 86(90001): i1 - 13.
[Full Text] [PDF]

Home page
 HeartHome page
N. Galiè and A. Torbicki
GENERAL CARDIOLOGY: Pulmonary arterial hypertension: new ideas and perspectives
Heart, April 1, 2001; 85(4): 475 - 480.
[Full Text]

Home page
 ChestHome page
T. Menzel, S. Wagner, T. Kramm, S. Mohr-Kahaly, E. Mayer, S. Braeuninger, and J. Meyer
Pathophysiology of Impaired Right and Left Ventricular Function in Chronic Embolic Pulmonary Hypertension : Changes After Pulmonary Thromboendarterectomy
Chest, October 1, 2000; 118(4): 897 - 903.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
B.M Weiss and O.M Hess
Pulmonary vascular disease and pregnancy: current controversies, management strategies, and perspectives
Eur. Heart J., January 2, 2000; 21(2): 104 - 115.
[PDF]

Home page
 Journal Watch CardiologyHome page
Atrial Septostomy for Severe Primary Pulmonary Hypertension
Journal Watch Cardiology, August 21, 1998; 1998(821): 9 - 9.
[Full Text]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement