Atrial septostomy for Pulmonary Hypertension

Overview
Some people with advanced pulmonary arterial hypertension (PAH) and severe right heart failure may be candidates for atrial septostomy surgery. Atrial septostomy can relieve pressure in the right side of the heart and reduce PAH symptoms. Atrial septostomy may be done as a palliative measure while a person with PAH waits for a lung transplant.

What does it involve?
The goal of atrial septostomy surgery is to create a small hole between the right and left atria of the heart to decompress the overburdened right side of the heart.

Atrial septostomy is commonly done under conscious sedation. Atrial septostomy is usually done in a cardiac catheterization laboratory, or cath lab, a specialized examination room in a hospital for heart-related tests and procedures.

The cardiologist begins angioplasty by making a small hole in your arm or groin with a needle, then inserting a thin, flexible guide wire. The cardiologist will insert a thin tube called a catheter over the guide wire into your artery and remove the guide wire. Dye may be injected into the catheter to help the doctor image your heart. Next, the surgeon will insert a small needle or blade via the catheter and make a small opening in the heart. The balloon catheter is threaded through the opening made by the blade or needle and inflated to dilate the opening. When the catheter is removed, it will leave a small hole between the atria.

Recovery
After atrial septostomy surgery, you will need to spend about 48 hours being observed in the hospital’s intensive care unit (ICU). You will likely receive supplemental oxygen.

Results
The average survival duration for people with PAH who have undergone atrial septostomy is slightly longer than five years. Approximately 90 percent of those who have the procedure experience significant improvements after two to four weeks of symptoms including syncope, edema (swelling in the extremities), and ascites (swelling in the abdomen).

Constraints
The mortality rate for atrial septostomy is approximately 15 percent.

Any surgical procedure performed on the heart carries risks including bleeding, blood clots, damage to the artery, severe reactions to medication or dye, heart attack or stroke, and death.

Atrial septostomy may not improve your PAH symptoms.

You may need to undergo repeat atrial septostomy procedures to maintain the opening.

Atrial septostomy does not cure the underlying PAH. Over time, the disease can worsen, and symptoms of dyspnea (breathing difficulty) and hypoxemia (too little oxygen in the blood) can reappear.

For more details about this treatment, visit:

Atrial septostomy – Pulmonary Hypertension Association UK
http://www.phauk.org/treatment-for-pulmonary-hy...

Atrial Septostomy: A Contemporary Review – Wiley Online Library
http://onlinelibrary.wiley.com/doi/10.1002/clc....