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Putra SD, Prakoso R, Sembiring AA, Sakti DDA, Adiarto S, Mangkuanom AS, Kurniawati Y. Palliative interatrial septum stenting with a vascular stent in a chronic thromboembolic pulmonary hypertension patient: Is it beneficial? Egypt Heart J 2023; 75:70. [PMID: 37573270 PMCID: PMC10423174 DOI: 10.1186/s43044-023-00397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/29/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious disease that can progress and lead to a deadly outcome. Despite optimal drug therapy, pulmonary hypertension (PH) remains fatal. Untreatable right heart failure (RHF) from CTEPH is eventually a significant cause of death. However, unloading the right heart and increasing systemic output are the treatment goals in these patients. CASE PRESENTATION A 42-year-old female presented to the emergency department with worsening dyspnea experienced for three days before admission. There were also complaints of leg edema, ascites, orthopnea, and palpitation. Physical examination revealed an attenuated second heart sound, abdominal ascites, and bilateral leg edema. She had a history of frequent readmissions due to RHF despite optimal medical therapy and was diagnosed with CTEPH 5 months ago. It was decided that the patient would undergo interatrial septal (IAS) stenting with a vascular stent of 8 mm × 39 mm × 135 cm. The results were good; her symptoms and signs of RHF improved, and she was eventually discharged from the hospital. Four months after the procedure, the patient was able to engage in physical activities without any limitations. CONCLUSIONS A palliative IAS stent is one of the choices for intractable RHF management in patients with CTEPH. The vascular stent can be used as an alternative in order to make the interatrial connection more stable and last longer.
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Affiliation(s)
- Swastya Dwi Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, DKI Jakarta, 11420, Indonesia
- National Cardiovascular Center, Harapan Kita, Letjen S. Parman Kav. 87, West Jakarta, DKI Jakarta, 11420, Indonesia
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, DKI Jakarta, 11420, Indonesia
- National Cardiovascular Center, Harapan Kita, Letjen S. Parman Kav. 87, West Jakarta, DKI Jakarta, 11420, Indonesia
| | - Aditya Agita Sembiring
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, DKI Jakarta, 11420, Indonesia
- National Cardiovascular Center, Harapan Kita, Letjen S. Parman Kav. 87, West Jakarta, DKI Jakarta, 11420, Indonesia
| | - Damba Dwisepto Aulia Sakti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, DKI Jakarta, 11420, Indonesia
- National Cardiovascular Center, Harapan Kita, Letjen S. Parman Kav. 87, West Jakarta, DKI Jakarta, 11420, Indonesia
| | - Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, DKI Jakarta, 11420, Indonesia
- National Cardiovascular Center, Harapan Kita, Letjen S. Parman Kav. 87, West Jakarta, DKI Jakarta, 11420, Indonesia
| | - Arwin Saleh Mangkuanom
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, DKI Jakarta, 11420, Indonesia
- National Cardiovascular Center, Harapan Kita, Letjen S. Parman Kav. 87, West Jakarta, DKI Jakarta, 11420, Indonesia
| | - Yovi Kurniawati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, DKI Jakarta, 11420, Indonesia.
- National Cardiovascular Center, Harapan Kita, Letjen S. Parman Kav. 87, West Jakarta, DKI Jakarta, 11420, Indonesia.
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Yan C. Is combined use of radiofrequency ablation and balloon dilation the future of interatrial communications? Expert Rev Cardiovasc Ther 2022; 20:895-903. [PMID: 36329641 DOI: 10.1080/14779072.2022.2144233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Personalized and stable interatrial communication is an important palliative therapy for patients with heart failure. However, this remains a technically challenging task. AREAS COVERED In the past decades, substantial advancements in atrial septostomy for the creation of controllable and durable interatrial communication have been made, and numerous novel devices and techniques are in various stages of development. In this review, we discuss the evolving indications for atrial septostomy, current approaches with or without device implantation, and indicators for optimal interatrial communication. The combined use of radiofrequency ablation and balloon dilation (CURB) is an individualized management approach based on underlying hemodynamics, which demonstrates unique advantages in creating a sufficient interatrial communication with satisfactory stability. The advantages and disadvantages of this implant-free procedure are analyzed and its clinical prospects are assessed. EXPERT OPINION With ready availability, high safety, and efficacy, CURB is a promising procedure for creating personalized and stable interatrial communication without device implantation. Further research is required to simplify the procedure, screen optimal reference parameters for personalized therapy, and evaluate the long-term outcome in a large population of patients.
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Affiliation(s)
- Chaowu Yan
- Department of Structural Heart Disease, Fuwai Hospital, 100037, Beijing, China
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Welker CC, Huang J, Boswell MR, Spencer PJ, Theoduloz MAV, Ramakrishna H. Left Ventricular Decompression in VA-ECMO: Analysis of Techniques and Outcomes. J Cardiothorac Vasc Anesth 2022; 36:4192-4197. [PMID: 35965232 DOI: 10.1053/j.jvca.2022.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Carson C Welker
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey Huang
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Michael R Boswell
- Division of Cardiovascular Anesthesi, Mayo Clinic, Rochester, MN, United States
| | - Philip J Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Harish Ramakrishna
- Division of Cardiovascular Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55901, United States.
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Hyder SN, Chatterjee S, Aggarwal V. Percutaneous Treatments for Pulmonary Hypertension: Reviewing the Growing Procedural Role for Interventional Cardiology. Interv Cardiol Clin 2022; 11:293-305. [PMID: 35710284 DOI: 10.1016/j.iccl.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pulmonary arterial hypertension is a common and highly morbid medical problem resulting in elevated pulmonary arterial pressures and pulmonary vascular resistance. Medical therapies are costly, and not always well-tolerated. Surgical therapies such as pulmonary endarterectomy and lung transplantation are limited to a small subset of patients due to various patient, disease, or institutional factors. Over the past decade, there has been growing investigation into endovascular interventional therapies for patients with pulmonary hypertension such as balloon pulmonary angioplasty and pulmonary denervation. In this review, we describe the current status, future directions, and our recommendations on technical considerations with these therapies.
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Affiliation(s)
- S Nabeel Hyder
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan Medical School, 1500 East, Medical Center Drive, SPC 5860, Ann Arbor, MI 48109, USA
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, North Shore-Long Island Jewish Medical Centers, Northwell Health, Zucker School of Medicine, 270-05 76(th) Avenue, New Hyde Park, NY 11040, USA
| | - Vikas Aggarwal
- Division of Cardiology (Frankel Cardiovascular Center), Department of Internal Medicine, University of Michigan Medical School, 1500 East, Medical Center Drive, SPC 5860, Ann Arbor, MI 48109, USA.
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Piechura LM, Rinewalt DE, Mallidi HR. Advanced Surgical and Percutaneous Approaches to Pulmonary Vascular Disease. Clin Chest Med 2021; 42:143-154. [PMID: 33541608 DOI: 10.1016/j.ccm.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite progress in modern medical therapy, pulmonary hypertension remains an unremitting disease. Once severe or refractory to medical therapy, advanced percutaneous and surgical interventions can palliate right ventricular overload, bridge to transplantation, and overall extend a patient's course. These approaches include atrial septostomy, Potts shunt, and extracorporeal life support. Bilateral lung transplantation is the ultimate treatment for eligible patients, although the need for suitable lungs continues to outpace availability. Measures such as ex vivo lung perfusion are ongoing to expand donor lung availability, increase rates of transplant, and decrease waitlist mortality.
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Affiliation(s)
- Laura M Piechura
- Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Daniel E Rinewalt
- Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Hari R Mallidi
- Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Abstract
Right heart failure is a clinical syndrome of various causes that commonly involves failure of the right ventricle (RV). The hemodynamic hallmark of the syndrome is increasing central venous pressure and worsening cardiac output with a rising RV end-diastolic pressure. When dealing with RV failure, clinicians must assess and optimize the intravascular volume state, support RV contractility, and address any pathologic elevations of afterload so that systemic perfusion is preserved. Despite these measures, there may still be a need to offer rescue interventions to the failing RV in carefully selected patients.
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Affiliation(s)
- Cyrus A Kholdani
- Pulmonary Vascular Disease Program, Pulmonary, Critical Care, & Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, 15 York Street, LCI 105, New Haven, CT 06510, USA
| | - Wassim H Fares
- Pulmonary Vascular Disease Program, Pulmonary, Critical Care, & Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, 15 York Street, LCI 105, New Haven, CT 06510, USA.
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Sandoval J, Gomez-Arroyo J, Gaspar J, Pulido-Zamudio T. Interventional and surgical therapeutic strategies for pulmonary arterial hypertension: Beyond palliative treatments. J Cardiol 2015; 66:304-14. [PMID: 25769400 DOI: 10.1016/j.jjcc.2015.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 10/23/2022]
Abstract
Despite significant advances in pharmacological treatments, pulmonary arterial hypertension remains an incurable disease with an unreasonably high morbidity and mortality. Although specific pharmacotherapies have shifted the survival curves of patients and improved exercise endurance as well as quality of life, it is also true that these pharmacological interventions are not always accessible (particularly in developing countries) and, perhaps most importantly, not all patients respond similarly to these drugs. Furthermore, many patients will continue to deteriorate and will eventually require an additional, non-pharmacological, intervention. In this review we analyze the role of atrial septostomy and Potts anastomosis in the management of patients with pulmonary arterial hypertension, we summarize the current worldwide clinical experience (case reports and case series), and discuss why these interventional/surgical strategies might have a therapeutic role beyond that of a "bridge" to transplantation.
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Affiliation(s)
- Julio Sandoval
- Department of Cardiopulmonary, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico.
| | - Jose Gomez-Arroyo
- Department of Cardiopulmonary, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University-School of Medicine, Baltimore, MD, USA
| | - Jorge Gaspar
- Department of Interventional Cardiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico
| | - Tomas Pulido-Zamudio
- Department of Cardiopulmonary, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico
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Abstract
Selected children with congenital heart defects undergoing palliative closed heart procedures require a cardiopulmonary bypass (CPB) run only for the purpose of creating an inter-atrial communication. We report a simple technique of atrial septostomy using thoracoscopy scissors under transesophageal echocardiography guidance without the need for CPB.
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Affiliation(s)
- Raj R Benedict
- Department of Pediatric Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Anuj Kumar
- Department of Pediatric Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Edwin Francis
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
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Abstract
This article summarizes the current literature regarding surgical interventions in pulmonary hypertension, excluding chronic thromboembolic pulmonary hypertension. The article discusses the use of atrial septostomy in patients meeting criteria as well as single, double, and heart-lung transplantation.
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Affiliation(s)
- Stephanie G Norfolk
- Division of Pulmonary and Critical Care, Duke University Medical Center, DUMC 102342, Durham, NC 27710, USA
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Roy AK, Gaine SP, Walsh KP. Percutaneous atrial septostomy with modified butterfly stent and intracardiac echocardiographic guidance in a patient with syncope and refractory pulmonary arterial hypertension. Heart Lung Circ 2013; 22:668-71. [PMID: 23402682 DOI: 10.1016/j.hlc.2013.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 11/12/2012] [Accepted: 01/08/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Syncope is associated with poor prognosis in patients with pulmonary hypertension. Atrial septostomy improves cardiac index and functional class in appropriately selected patients with pulmonary hypertension, and has been shown to improve syncope. One of the major challenges to its effectiveness is maintaining septostomy patency. We report the case of percutaneous deployment of a modified peripheral stent to create an atrial septostomy in a man with severe pulmonary hypertension and syncope, initially intolerant of medical therapy. PROCEDURES Percutaneous butterfly stent deployment across the interatrial septum using intracardiac echocardiography and fluoroscopy. FINDINGS The patient improved in all clinical parameters (BNP, six-minute walk test, dyspnoea score), and was subsequently able to tolerate targeted pulmonary hypertension therapies. PRINCIPAL CONCLUSIONS Atrial septostomy using butterfly stents to maintain patency may play a role in the treatment of patients with advanced pulmonary hypertension who do not respond to targeted therapy.
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Affiliation(s)
- Andrew K Roy
- Mater Misericordiae University Hospital, Dublin 7, Ireland.
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