Website is intended for physicians



Introduction: pulmonary arterial hypertension (PAH) is a pathophysiological syndrome that can occur in a variety of clinical conditions. Percutaneous balloon dilatation and stent implantation are methods for creating or expanding atrial communication in a variety of conditions to improve cardiac output. It should be kept in mind that creation of an inadequate size of the shunt leads to an excess of right-left shunt, worsening of pulmonary blood flow, severe hypoxemia, and acute left ventricular failure. Possibility of a calculated determination of required size of shunt in the interatrial septum will increase the effectiveness and safety of atrioseptostomy, which is especially important in this severe category of patients.

Aim: to substantiate a method of determining of optimal diameter of the atrial communication during atrioseptostomy in patients with PAH for increase of exercise tolerance, prevention of syncope and reducing the risk of sudden death.

Materials and methods: the choice of the diameter of the interatrial communication during atrioseptostomy operation in patients with PAH is as follows: before the operation, patient undergoes an invasive measurement of pressure in right and left atrium and determination of stroke volume of left ventricle. Then calculation the diameter of the interatrial communication according to the formula is performed. We performed calculation according to presented formula in 4 patients with PAH. In 2 patients, a fenestrated occluder was implanted, in 1 patient atrial septum stenting was performed, and 1 patient underwent open atrioseptostomy.

Results: in all patients after atrioseptostomy, an improvement in quality of life was observed: decreased dyspnea, increased exercise tolerance, decreased edema of lower limbs, and the absence of syncopal conditions. Thus, after the operation, there was a positive dynamics in clinical status of patients, indicators of test with a six-minute walk, as well as changes in echocardiographic indicators: a decrease in the size of the right ventricle and square area of right atrium, an increase in the end-diastolic size of the left ventricle, which indicates an improvement in function of both ventricles.

Conclusion: a mathematical model based on principles of intracardiac hemodynamics, demonstrates the importance of choosing of size of foramen to create a certain Qp/Qs. Size of foramen, depending on the pressure in atrium, in conditions of high pulmonary hypertension has a small range of values (from 6 to 8 mm). Therefore, the use of the 7 mm size, previously obtained empirically by other authors, is physically justified. Our first experience testifies to applicability of the developed model, but due to the small number of observations associated with the rarity of the pathology, it requires further research.



1.     Micheletti A, Hislop AA, Lammers A, et al. Role of atrial septostomy in the treatment of children with pulmonary arterial hypertension. Heart. 2006; 92: 969-72.

2.     Baglini R, Scardulla C., Reduction of a previous atrial septostomy in a patient with end-stage pulmonary hypertension by a manually fenestrated device. Cardiovasc Revasc Med. 2010; 11(4).

3.     Stümper O, Gewillig M, Vettukattil J, et al. Modified technique of stent fenestration of the atrial septum. Heart. 2003; 89: 1227-30.

4.     Sivaprakasam M, Kiesewetter C, Veldtman GR, et al. New technique for fenestration of the interatrial septum. J Interv Cardiol. 2006; 19: 334-6.

5.     Alekyan BG, Pursanov MG. Atrial septal stenting. Textbook of endovascular surgery for cardiovascular diseases. AN Bakulev National Medical Research Center of Cardiovascular Surgery. 2008; 2: 57-65 [In Russ].

6.     Gorbachevsky SV, Belkina MV, Pursanov MG, et al. Atrial septostomy as a long bridge to lung transplantation in patients with idiopathic pulmonary arterial hypertension. J. Cardiovasc. Surg. 2012; 53(2): 11 [In Russ].

7.     Alekyan BG, Gorbachevskiy SV, Pursanov MG, et al. Atrial septal stenting with idiopathic pulmonary hypertension. AN Bakulev National Medical Research Center of Cardiovascular Surgery. Thoracic and Cardiovascular Surgery. 2016; 58(5): 258-314 [In Russ].

8.     Pardaev DB, Alekyan BG, Gorbachevskiy SV, et al. Atrioseptostomy with atrial septum stenting in patients with idiopathic pulmonary hypertension. AN Bakulev National Medical Research Center of Cardiovascular Surgery. 2017 [In Russ].

9.     Weimar T, Watanabe Y, Kazui T, et al. Impact of differential right-to-left shunting on systemic perfusion in pulmonary arterial hypertension. Cathet. Cardiovasc. Interv. 2013; 81(5): 888-95.

10.   Sandoval J, Arroyo JG, Gaspar J, et al. Interventional and surgical therapeutic strategies for pulmonary arterial hypertension: Beyond palliative treatments. J. Cardiol. 2015; 66: 304-4.

11.   Lammers AE, Derrick G, Haworth SG, et al. Efficacy and long-term patency of fenestrated Amplatzer devices in children. Cathet. Cardiovasc. Interv. 2007; 70(4): 578-84.

12.   Shmaltc АА, Nishonov NА. Atrioseptostomy in patients with pulmonary hypertension. Thorax and Cardiovascular Surgery. 2015; 57(5): 18-25 [In Russ].

13.   Chiu JS, Zuckerman WA, Turner ME, et al. Balloon atrial septostomy in pulmonary arterial hypertension: effect on survival and associated outcomes. J Heart Lung Transplant. 2015; 34(3): 376-380.

14.   Hirsch R, Bagby MC, Zussman ME. Fenestrated ASD closure in a child with idiopathic pulmonary hypertension and exercise desaturation. Congenit Heart Dis. 2011; 6(2): 162-166.

15.   Kurzyna M, Dabrowski M, Bielecki D, et al. Atrial septostomy in treatment of end-stage right heart failure in patients with pulmonary hypertension. Chest. 2007; 131(4): 977-983.

16.   Patel MB, Samuel BP, Girgis RE, et al. Implantable atrial flow regulator for severe, irreversible pulmonary arterial hypertension. EuroIntervention. 2015; 11(6): 706-709.

17.   Kapoor A, Khanna R, Batra A, et al. Inoue balloon atrial septostomy in severe persistent pulmonary hypertension following surgical ASD closure. J Cardiol Cases. 2012; 6(1): 1-3.

18.   Rajeshkumar R, Pavithran S, Sivakumar K, et al. Atrial septostomy with a predefined diameter using a novel occlutech atrial flow regulator improves symptoms and cardiac index in patients with severe pulmonary arterial hypertension. Catheter Cardiovasc Interv. 2017; 90(7): 1145-1153.

19.   Baglini R, Scardulla C. Reduction of a previous atrial septostomy in a patient with end-stage pulmonary hypertension by a manually fenestrated device. Cardiovasc Revasc Med. 2010; 11(4).

20.   Alekyan BG, Gorbachevsky SV, Pursanov MG, et al. Stenting of the interatrial septum for the treatment of idiopathic pulmonary arterial hypertension. J. Invasive Cardiol. 2015 [In Russ].

21.   Koval PV. Hydraulics and hydraulic lines of mining machines: Textbook for universities in the specialty «Mining machines and complexes». Engineering. 1979. (АНГИОЛОГИЯ.ру) - портал о диагностике и лечении заболеваний сосудистой системы