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Abstract:

Introduction: pulmonary arterial hypertension (PAH) is a disease characterized by a progressive increase in pulmonary vascular resistance that leads to the development of right ventricular heart failure and premature death of patients. Today, there are several ways to create an atrial communication: balloon dilatation, Park procedure, balloon knife atrial septostomy, atrial septum stenting and implantation of fenestrated occluder.

The main problem with positioning of the device is that the atrial septum is not visible on fluoroscopy, where the stent is visible throughout. And the stent is not visible throughout on echocardiography, where the septum is visible. Exactly for this operation, the combination of echo- and fluoroscopic image in real time is very useful in order to accurately place in the middle at the level of stent in the septum and to avoid its dislocation with embolization of right or left heart chambers, or vessels of pulmonary and systemic circuit.

Material and methods: we present a case report of atrial septostomy with stent implantation into the atrial septum using the EchoNavigator® hybrid imaging system in a patient with pulmonary arterial hypertension.Surgical intervention was performed on a patient with PAH: atrial septostomy with intubation anesthesia under the control of fluoroscopy and transesophageal echocardiography (TEE) using the EchoNavigator® system. The procedure was performed using a Palmaz stent, that was implanted without additional fixation.

Results: patient with pulmonary hypertension underwent an atrial septostomy using the EchoNavigator® hybrid imaging system, which was used for positioning and implantation of stent into the atrial septum as quickly and accurately as possible. This surgical intervention significantly improved patient's clinical condition, cardiac hemodynamics and, accordingly, increased the quality of life.

Conclusion: atrial septostomy is a surgical method for patients with severe pulmonary arterial hypertension. Carrying out this operation under the control of the EchoNavigator® system with the function of hybrid imaging in real time greatly facilitated the procedure for positioning and implanting of stent, facilitated the safe implementation.

 

References

1.     Gali? N, Rubin L. Pulmonary arterial hypertension. Epidemiology, pathobiology, assessment and therapy. Journal of the American College of Cardiology. 2004; 43:1–90.

2.     Badesch DB, Abman SH, Simonneau G, et al. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest. 2007; 131:1918–28.

http://doi.org/10.1378/chest.06-2674

3.     Reichenberger F, Pepke-Zaba J, McNeil K, et al. Atrial seprostomy in the treatment of severe pulmonary arterial hypertension. Thorax. 2003; 58:797–800.

http://doi.org/10.1136/thorax.58.9.797

4.     Law M, Grifka RG, Mullins CE, et al. Atrial septostomy improves survival in select patients with pulmonary hypertension. Am Heart J. 2007; 153:779–84.

http://doi.org/10.1016/j.ahj.2007.02.019

5.     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; 131:977–83.

http://doi.org/10.1378/chest.06-1227

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; 53:11.

7.     Alekyan BG, Gorbachevsky SV, Pursanov MG, et al. Atrial septal stenting in idiopathic pulmonary hypertension. Journal of thoracic and cardiovascular surgery. 2016; 58(5): 258-314 [In Russ].

8.     Schmaltz АА, Nishonov NА. Atrioseptostomy in patients with pulmonary hypertension. Journal of thoracic and cardiovascular surgery. 2015; 57(5): 18-25 [In Russ].

9.     Sandoval J, Gaspar J, Pena H, et al. Effect of atrial septostomy on the survival of patients with severe pulmonary arterial hypertension. Eur. Respir. J. 2011; 38: 1343–8.

http://doi.org/10.1183/09031936.00072210

10.   Chiu S, Zuckerman WA, Turner ME, et al. Balloon atrial septostomy in pulmonary arterial hypertension: Effect on survival and associated outcomes. J. Heart Transplant. 2015;34(3):376-80.

http://doi.org/10.1016/j.healun.2015.01.004

11.   Fraisse A, Chetaille P, Amin Z, et al. Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension. Pediatr. Cardiol. 2006; 27: 759–62.

12.   O’loughlin AJ, Keogh A, Muller DW. Insertion of a fenestrated Amplatzer atrial septostomy device for severe pulmonary hypertension. Heart Lung Circ. 2006; 15: 275–7.

http://doi.org/10.1016/j.hlc.2006.02.002

13.   Prieto LR, Latson LA, Jennings C. Atrial septostomy using a butterfly stent in a patient with severe pulmonary arterial hypertension. Cathet. Cardiovasc. Interv. 2006; 68: 642–7.

http://doi.org/10.1002/ccd.20745

14.   Althoff TF, Knebel F, Panda A, et al. Longterm follow-up of a fenestrated Amplatzer atrial septal occlude in pulmonary arterial hypertension. Chest. 2008; 133; 283–5.

http://doi.org/10.1378/chest.07-1222

15.   Troost E, Delcroix M, Gewillig M, et al. A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension. Cathet. Cardiovasc. Interv. 2008; 73: 173–9.

https://doi.org/10.1002/ccd.21760

16.   Roy AK, Gaine SP, Walsh KP. Percutaneous atrial septostomy with modified butterfly stent and intracardiac echocardiographic guidance in a patient with syncope and refractory pulmonary arterial hypertension. Heart Lung Circ. 2013; 22(8):668–71.

https://doi.org/10.1016/j.hlc.2013.01.005

17.   Alekyan BG, Pursanov MG. Atrial septal stenting. Guide to endovascular surgery of the heart and blood vessels. 2008; 2:57–65 [In Russ].

18.   Sager JS, Ahya VN. Surgical therapies for pulmonary arterial hypertension. Clin. Chest Med. 2007; 28: 187–202.

https://doi.org/10.1016/j.ccm.2006.11.003

19.   Unger P, Stoupel E, Vachiery JL, et al. Atrial septostomy under transesophageal guidance in a patient with primary pulmonary hypertension and absent right superior vena cava. Intensive Care Med. 1996; 22:1410–11.

https://doi.org/10.1007/BF01709560

20.   Bidoggia H, Maciel JP, Alvarez JA. Transseptal left heart catheterization: usefulness of the intracavitary electrocardiogram in the localization of the fossa ovalis. Cathet. Cardiovasc. Diagn. 1991; 24:221–5.

https://doi.org/10.1002/ccd.1810240318

21.   Moscucci M, Dairywala IT, Chetcuti S, et al. Balloon atrial septostomy in end-stage pulmonary hypertension guided by a novel intracardiac echocardiographic transducer. Cathet. Cardiovasc. Interv. 2001; 52:530–4.

https://doi.org/10.1002/ccd.1116

22.   Sorajja P, Cabalka AK, Hagler DJ, et al. Long-term follow-up of percutaneous repair of paravalvular prosthetic regurgitation. J Am Coll Cardiol. 2011; 58:2218–2224.

https://doi.org/10.1016/j.jacc.2011.07.041

23.   Zorinas A, Janusauskas V, Davidavicius G, et al. Fusion of real-time 3D transesophageal echocardiography and cardiac fluoroscopy imaging in transapical catheter-based mitral paravalvular leak closure. Advances in Interventional Cardiology. 2017; 13(3):263-268.

https://doi.org/10.5114/aic.2017.70200

24.   Corti R, Biaggi P, Gaemperli O, et al. Integrated x-ray and echocardiography imaging for structural heart interventions. EuroIntervention. 2013; 9:863-869.

https://doi.org/10.4244/EIJV9I7A140

25.   S?ndermann SH, Biaggi P, Gr?nenfelder J, et al. Safety and feasibility of novel technology fusing echocardiography and fluoroscopy images during MitraClip interventions. EuroIntervention. 2014; 9:1210-1216.

https://doi.org/10.4244/EIJV9I10A203

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