Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension -: A therapeutic alternative for patients nonresponsive to vasodilator treatment
Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension -: A therapeutic alternative for patients nonresponsive to vasodilator treatment
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DOI：
10.1016/s0735-1097(98)00238-1
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发表时间：
1998-08-01
影响因子：
24
通讯作者：
Gómez, A
中科院分区：
文献类型：
--
作者：
Sandoval, J;Gaspar, J;Gómez, A
我们试图研究分级球囊扩张房间隔造口术（BDAS）的急性血流动力学影响，并确定该手术的长期影响和纽约心脏协会功能分级以及原发性肺动脉高压（PPH）成年患者的生存率。目前对严重难治性PPH患者的治疗策略受到技术困难、高死亡率或高成本的限制。我们研究了15例重度PPH患者。所有患者均成功完成BDAS手术，首先使用Brockenbrough针穿过房间隔，然后使用Mansfield球囊在血流动力学控制下逐步扩张房间隔。BDAS导致右心室舒张末压和全身动脉血氧饱和度立即显著下降，心脏指数升高。1名患者死亡，14名患者存活，并显著改善了他们的平均功能等级（从3.57 +/- 0.6到2.07 +/- 0.3 [mean +/- SD], p < 0.001）。运动耐力（6分钟测试）也从107 +/- 127提高到217 +/- 108 m （p < 0.001）。由于自发性关闭，4例患者重复了BDAS。术后存活患者的1年、2年和3年生存率为92%，优于既往对照PPH患者（分别为73%、59%和52%）。经过仔细监测，BDAS是一种安全有效的姑息性治疗，适用于某些严重PPH患者。(C) 1998年由美国心脏病学会发布。
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 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. 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. (C) 1998 by the American College of Cardiology.