Atrial septostomy in the management of pulmonary arterial hypertension: past, present, and future.

Pulmonary arterial hypertension (PAH) is currently an irreversible disease, with many patients eventually progressing to right heart failure, severely affecting their quality of life and posing a life-threatening risk. Percutaneous atrial septostomy was first performed in infants with transposition of the great arteries in 1966. Since then, it has been used as a palliative treatment for patients with end-stage PAH, significantly improving their quality of life and providing a buffer period while waiting for lung transplantation. However, this method does not fundamentally alter the malignant outcomes of patients with PAH. This study reviews the development and evolution of atrial septostomy, summarises various emerging technologies, and systematically explains the mechanisms, efficacy, and prognosis of palliative treatment in patients with PAH. Furthermore, new ideas for this treatment approach are proposed with the hope that it will bring more benefits to patients with PAH in the future and be more fully utilised.