Pulmonary hypertension surgery: Difference between revisions
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===Atrial Septostomy=== | ===Atrial Septostomy=== | ||
Atrial septostomy is a surgical procedure that creates a | Atrial septostomy is a surgical procedure that creates a shunt between the right and left [[atria]]. It relieves pressure on the right side of the heart, but at the cost of lower oxygen levels in blood ([[hypoxia]]). It is best performed in experienced centers. | ||
Graded balloon dilatation of atrial septostomy is the recommended type of artial septostomy.<ref name="pmid9708453">{{cite journal| author=Sandoval J, Gaspar J, Pulido T, Bautista E, Martínez-Guerra ML, Zeballos M et al.| title=Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension. A therapeutic alternative for patients nonresponsive to vasodilator treatment. | journal=J Am Coll Cardiol | year= 1998 | volume= 32 | issue= 2 | pages= 297-304 | pmid=9708453 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9708453 }} </ref> Atrial septostomy might be considered among PH patients with [[pulmonary hypertension classification#WHO Functional Classification|WHO functional class IV]] and [[right heart failure]] refractory to therapy.<ref name="pmid17426198">{{cite journal| author=Kurzyna M, Dabrowski M, Bielecki D, Fijalkowska A, Pruszczyk P, Opolski G et al.| title=Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension. | journal=Chest | year= 2007 | volume= 131 | issue= 4 | pages= 977-83 | pmid=17426198 | doi=10.1378/chest.06-1227 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17426198 }} </ref> Atrial septostomy should also be considered among PH patients who have Eisenmenger's syndrome, idiopathic PAH, and those awaiting lung transplantation.<ref name="pmid19713419">{{cite journal| author=Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA et al.| title=Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 20 | pages= 2493-537 | pmid=19713419 | doi=10.1093/eurheartj/ehp297 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19713419 }} </ref> | |||
===Lung Transplantation=== | |||
[[Lung transplantation]] cures pulmonary arterial hypertension, but leaves the patient with the complications of transplantation, and a survival of about 5 years. | |||
===Pulmonary thromboendarterectomy=== | ===Pulmonary thromboendarterectomy=== | ||
Revision as of 16:23, 30 August 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Richard Channick, M.D.; Assistant Editor(s)-in-Chief: Ralph Matar, Lisa Prior, Ann Slater, R.N., Rim Halaby
Overview
Patient with severe pulmonary hypertension refractory to medical therapy can be candidate for surgical intervention. Atrial septostomy is a surgical procedure that creates a communication between the right and left atria. It relieves pressure on the right side of the heart, but at the cost of lower oxygen levels in blood (hypoxia).
Lung transplantation cures pulmonary arterial hypertension, but leaves the patient with the complications of transplantation, and a post-surgical median survival of just over five years.
Pulmonary thromboendarterectomy (PTE) is a surgical procedure that is used for chronic thromboembolic pulmonary hypertension. It is the surgical removal of an organized thrombus (clot) along with the lining of the pulmonary artery; it is a very difficult, major procedure that is currently performed in a few select centers. Case series show remarkable success in most patients.
Surgery
Atrial Septostomy
Atrial septostomy is a surgical procedure that creates a shunt between the right and left atria. It relieves pressure on the right side of the heart, but at the cost of lower oxygen levels in blood (hypoxia). It is best performed in experienced centers.
Graded balloon dilatation of atrial septostomy is the recommended type of artial septostomy.[1] Atrial septostomy might be considered among PH patients with WHO functional class IV and right heart failure refractory to therapy.[2] Atrial septostomy should also be considered among PH patients who have Eisenmenger's syndrome, idiopathic PAH, and those awaiting lung transplantation.[3]
Lung Transplantation
Lung transplantation cures pulmonary arterial hypertension, but leaves the patient with the complications of transplantation, and a survival of about 5 years.
Pulmonary thromboendarterectomy
Pulmonary thromboendarterectomy (PTE) is a surgical procedure that is used for chronic thromboembolic pulmonary hypertension. It is the surgical removal of an organized thrombus (clot) along with the lining of the pulmonary artery; it is a large and very difficult procedure that is currently performed in a few select centers. Case series show remarkable success in most patients.
Treatment for hypoxic and miscellaneous varieties of pulmonary hypertension have not been established. However, studies of several agents are currently enrolling patients. Many physicians will treat these diseases with the same medications as for PAH, until better options become available.
References
- ↑ Sandoval J, Gaspar J, Pulido T, Bautista E, Martínez-Guerra ML, Zeballos M; et al. (1998). "Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension. A therapeutic alternative for patients nonresponsive to vasodilator treatment". J Am Coll Cardiol. 32 (2): 297–304. PMID 9708453.
- ↑ Kurzyna M, Dabrowski M, Bielecki D, Fijalkowska A, Pruszczyk P, Opolski G; et al. (2007). "Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension". Chest. 131 (4): 977–83. doi:10.1378/chest.06-1227. PMID 17426198.
- ↑ Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA; et al. (2009). "Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)". Eur Heart J. 30 (20): 2493–537. doi:10.1093/eurheartj/ehp297. PMID 19713419.