GRADED BALLOON DILATION ATRIAL SEPTOSTOMY IN SEVERE PRIMARY PULMONARY-HYPERTENSION - A THERAPEUTIC ALTERNATIVE FOR PATIENTS NONRESPONSIVE TO VASODILATOR TREATMENT

We sought to investigate the acute hemodynamic effects of graded ballo on dilation atrial septostomy (BDAS) and to define the long-term impac t of this procedure an 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. BD AS was successfully performed in all patients by crossing the interatr ial septum with a Brockenbrough needle, followed by progressive dilati on of the orifice with a Mansfield balloon in a hemodynamically contro lled, step-by-step manner. Results. BDAS caused an immediate significa nt fall in right ventricular end-diastolic pressure and in systemic ar terial 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, B DAS was repeated in four patients. The survival rate among patients wh o 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%, respe ctively). Conclusions. With careful monitoring, BDAS is a safe and use ful palliative treatment for selected patients with severe PPH. (C) 19 98 by the American College of Cardiology.