Clinical Studies
Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension: A therapeutic alternative for patients nonresponsive to vasodilator treatment

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Abstract

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

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

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