Author + information
- Gulamzhan Dadabaev,
- Leo Bockeria,
- Sergey Gorbachevskiy and
- Davronbek Pardaev
Background: Idiopathic pulmonary arterial hypertension (IPAH) is characterized by a progressive increase of pulmonary vascular resistance, that ultimately leads to the development of right ventricular failure.
Methods: In our Center stent fenestration of the atrial septum has been performed in 44 patients with iPAH aged from 5 to 34 years (mean 14.2±7.8). There were 26 (59,1%) females and 18 (40,9%) males. From 44 patients 23 (52,3%) were in functional class III of modified NYHA classification and 21 (47,7%) – class IV (according to the WHO 1998). All patients underwent standard clinical preoperative evaluation. Stent fenestration of the atrial septum was performed under intubation anesthesia through common femoral venous approach in all cases. The stenting of the interseptal fenestration (ISF) was performed using two techniques: direct stenting (36,3%) with 5-8 mm diameter and 20-30 mm length (Medtronic, Minneapolis, MN or Cordis, Switzerland) peripheral stents and “sand glass” shape stenting (61.4%) with Palmaz-Genesis (Cordis, Switzerland) stents.
Results: In 97.7% of cases interventions and creation of the ISF from 5.0 to 8.0 mm in diameter were successfully performed. Increase of systolic pressure in the pulmonary artery at mean from 105±45 to 125±40 mm hg with a slight decrease of arterial blood oxygen saturation (from 90±2% to 89±2%) was observed in all patients immediately after the intervention. Hospital mortality was 2,3%. Long-term evaluation was performed in 42 patients up to 7 years. One-year survival was 97%, 2-year was 95%, and 7-year was 93%. The walking distance after the procedure was 260 ± 120 meters, that up to 140 m more than before the procedure. 77% of patients were in WHO class I-III (2 in class I, 17 patients – in class II, 13 in class III) but 7 patients were still in class IV.
Conclusions: Stent fenestration of the atrial septum combined with specific medical therapy for idiopathic pulmonary arterial hypertension leads to positive changes of the hemodynamics, improvement of clinical status and quality of patient's life. The increasing life expectancy in such patients is the main reason for broad introduction of this technique into IPAH treatment.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in Pulmonary Arterial Hypertension
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1269-002
- 2017 American College of Cardiology Foundation