Atrial septostomy in patients with end-stage pulmonary hypertension. No more needles but wires, energy and close anatomical definition.

OBJECTIVES

To assess the usefulness of a new approach to atrial septal puncture and septostomy in patients with end-stage pulmonary hypertension.

BACKGROUND

Atrial septostomy in end-stage pulmonary hypertension has high mortality and morbidity rates mainly due to trans-septal catheterization. New approaches to safety during this technical step are expected.

METHODS

Twelve patients with end-stage pulmonary arterial hypertension (5 males, 7 females, mean age 41, 9 ± 12, 0 years) underwent to balloon atrial septostomy. Intracardiac echography (ICE) was used to localize fossa ovalis while a radiofrequency wire was used to perforate the atrial septum. Then a septostomy was performed by progressive balloon dilatation of atrial septum. Septal perforation was successful at the first attempt in 4 patients and after 5 attempts in a single case, while Bas was successful in all.

RESULTS

Pericardial effusion did not develop in any patient. Complications consisted in transient supraventricular tachyarrhythmia, transient cerebral ischemia and severe hypoxemia with ventricular tachycardia in 3 single patients. In-procedure death rate was 0%. Systemic cardiac output increased immediately, while systemic O2 saturation decreased significantly in all. Mean follow-up was 8, 2 ± 3, 8 months. Mortality was 16.6% (2 patients). NYHA class improved in the rest of patients. Four patients (33.2%) underwent to pulmonary transplant successfully.

CONCLUSIONS

This novel approach for trans-septal catheterization has shown very low rate of major complication during atrial septostomy in patients with end-stage pulmonary arterial hypertension.