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
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Figure 1 Follow-up transesophageal echocardiogram from a study patient. A, Echocardiogram at rest showing enlargement of the right ventricle and right atrium. An open atrial septostomy is clearly defined (arrow). B, Doppler demonstration of the functioning of septostomy is established by the existence of a mild right to left shunt at rest. Simultaneous measurement of SaO2% by pulse oxymetry at rest is 84%. C, Augmentation of right to left shunt at mild supine exercise can be clearly demonstrated. SaO2% decreased to 68% during this state.
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Figure 2 Exercise endurance, as assessed by the 6-min walk test, significantly increased after BDAS (from 107 ± 127 to 217 ± 108 m, n = 14, p < 0.001). A further improvement in exercise endurance (from 191 ± 101 to 284 ± 73 m, n = 10, p < 0.05 by the Bonferroni correction [15]) was also demonstrated at long-term evaluation.
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Figure 3 Kaplan-Meier estimates of survival among patients with PPH who underwent and survived BDAS (triangles) versus historic control patients from our own registry [12] with PPH who did not respond to vasodilator therapy (squares). The 1-, 2- and 3-year survival rates for patients who underwent atrial septostomy, as predicted by the equation developed from the National Institutes of Health Primary Pulmonary Hypertension Registry data (18) are also shown (circles).
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