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2020, Número 2

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Rev Cubana Cardiol Cir Cardiovasc 2020; 26 (2)


Septostomía auricular en paciente con Hipertensión Arterial Pulmonar y predictores de alto riesgo de mortalidad

Echarte MJC, Hechavarría PS, Alfonso RE, Felipe DS, Guevara MG, Yanes QAA

Idioma: Español
Referencias bibliográficas: 40
Paginas: 1-8
Archivo PDF: 306.77 Kb.


RESUMEN

Introducción: La Hipertensión Arterial Pulmonar Primaria es una enfermedad incurable, limita la capacidad funcional. La expectativa de vida es corta. Las prostaciclinas, prostanoides, inhibidores de los receptores de la endotelina e inhibidores de la fosfodiesterasa cinco mejoran la calidad de vida. En los trasplantes de pulmón y corazón-pulmón no reaparece dicha entidad. La bronquiolitis obliterante y la alta letalidad son elementos negativos a resolver en este tipo de pacientes. En Cuba, no se realizan actualmente ninguno de los dos.
La septostomía auricular, representa una alternativa terapéutica más, siendo en los países donde se realiza trasplante, el escalón previo a la realización del mismo. En nuestro caso, constituiría el último paso para enfrentar esta enfermedad. Dicho proceder en este tipo de pacientes, tiene alto riesgo de complicaciones y letalidad.
Se expone la introducción, por primera vez, de esta técnica en el país en una paciente con Hipertensión Arterial Pulmonar, la cual presentaba predictores elevados de fracaso y mortalidad transprocedimiento, el cual se realizó con éxito y sin complicaciones.
Conclusión: La septostomía Auricular, constituye una opción de tratamiento en la Hipertensión Arterial Pulmonar, que mejora la calidad de vida de estos enfermos. Se recomienda la realización de dicha técnica por manos expertas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal (2016) 37, 67–119

  2. Simonneau G, Galie ` N, Rubin LJ, Langleben D, Seeger W, Domenighetti G, Gibbs S, Lebrec D, Speich R, Beghetti M. Clinical classification of pulmonary

  3. Kovacs G, Berghold A, Scheidl S, et al. Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review. Eur Respir J 2009; 34: 888–894.

  4. Simonneau G, Montani D, Celermajer DS, et al.: Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019; 53(1): pii: 1801913.

  5. Sandoval Zárate J, Carrillo A, Córdova J, Martínez Guerra ML y cols. Tratamiento no farmacológico de la hipertensión arterial pulmonar. Alternativas de intervencionismo y cirugía. Neumología Y Cirugía De Tórax, Vol. 65, S4, 2006.

  6. Sitbon O, Gomberg-Maitland M, Granton J, et al. Clinical trial design and new therapies for pulmonary arterial hypertension. Eur Respir J 2018; in press [https://doi.org/10.1183/13993003.01908-2018].

  7. Austen WG, Morrow AG, Berry WB. Experimental studies of the surgical treatment of primary pulmonary hypertension. J Thorac Cardiovasc Surg 1964; 48: 448-55

  8. Rashkind WJ, Miller WW. Creation of an atrial septal defectwithout thoracotomy. A palliative approach to complete transposition of the great arteries. JAMA 1966; 196:173

  9. Park SC, Neches WH, Zuberbuhler JR, et al. Clinical Use of Blade Atrial Septostomy. Circulation 1978; 58: 600

  10. Park SC, Neches WH, Mullins CE, et al. Blade Atrial Septostomy: Collaborative Study. Circulation 1982; 66: 258

  11. Rich S, Lam W. Atrial Septostomy as palliative therapy for refractory primary pulmonary hypertension. Am J Cardiol 1983; 51: 1560-61

  12. Kerstein D, Levy PS, Hsu DT, et al. Blade balloon atrial septostomy in patients with severe primary pulmonary hypertension. Circulation 1995; 91: 2028-35

  13. Rich S, Dodin E, McLaughlin VV. Usefulness of atrial septostomy as a treatment for primary pulmonary hypertension and guidelines for its application. Am J Cardiol 1997; 80: 369-71.

  14. Hausknecht MJ, Sims RE, Nihill MR, et al. Successful palliation of primary pulmonary hypertension by atrial septostomy. Am J Cardiol 1990; 65: 1045-46

  15. Sandoval J, Gaspar J, Pulido T, et al. Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension. A therapeutic alternative for patients nonresponsive to vasodilator treatment. J Am Coll Cardiol 1998; 32: 297-304

  16. Badesch DB, Abman SH, Ahearn GS, Barst RJ, McCrory DC, Simonneau G, McLaughlin VV. Medical therapy for pulmonary arterial hypertension. ACCP Evidence-Based Clinical Practice Guidelines. Chest 2004; 126: 35S-62S.

  17. McLaughlin VV, Shillington A, Rich S. Survival in primary pulmonary hypertension: the impact of epoprostenol therapy. Circulation 2002; 106: 1477-1482.

  18. Galie N, Seeger W, Naeije R, et al. Comparative analysis of clinical trials and evidence-based treatment algorithm in pulmonary arterial hypertension. J Am Coll Cardiol 2004; 43: 81S-88S.

  19. J.A. Barberà, A. Román, M.A. Gómez-Sánchez, I. Blanco, R. Otero, R. López- Reyes, et al. Diagnóstico y tratamiento de la hipertensión pulmonar. Respira-Fundación Española del Pulmón-Sociedad Española de Neumología y Cirugía Torácica (SEPAR), (2017)

  20. N. Galie, M. Humbert, J.L. Vachiery, S. Gibbs, I. Lang, A. Torbicki, et al. ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint 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: Association for European Paediatric and Congenital Cardiology (AEPC) International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J, 46 (2015), pp. 903-975 http://dx.doi.org/10.1183/13993003.01032-2015 | Medline

  21. D’Alonso GE, Barst RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension. Results of a national prospective study. Ann Intern Med 1991; 115: 343-9

  22. Sandoval J, Gaspar J. Atrial Septostomy. In: Pulmonary Circulation 2nd Edition. Peacock AJ, Rubin LJ (Eds). Edward Arnold Publishers Ltd. London UK, 2004: 319-333

  23. Rothman A, Beltran D, Kriett JM, et al. Graded balloon dilation atrial septostomy as a bridge to Transplantation in primary pulmonary hypertension. Am Heart J 1993;125: 1763-66

  24. Rothman A, Slansky MS, Lucas VW, et al. Atrial septostomy as a bridge to Lung Transplantation in patients with severe pulmonary hypertension. Am J Cardiol 1999; 84:682-686

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

  26. Vachiery JL, Stoupel E, Boonstra A, Naeije R. Balloon atrial septostomy for pulmonary hypertension in the prostacyclin era. Am J Respir Crit Care Med 2003; 167: A692

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

  28. Kothari SS, Yusuf A, Juneja R, et al. Graded balloon atrial septostomy in severe pulmonary hypertension. Indian Heart J 2002; 54: 164-9

  29. Allcock RJ, O’Sullivan JJ, Corris PA. Atrial septostomy for pulmonary hypertension. Heart 2003; 89: 1344-1347

  30. Kurzyna M, Dabrowsky M, Torbicki A, et al. Atrial septostomy for severe primary pulmonary hypertension. Report of two cases. Kardiol Pol 2003; 58: 27-33

  31. Chau EMC, Fan KYY, Chow WH. Combined atrial septostomy and oral sildenafil for severe right ventricular failure due to primary pulmonary hypertension. Hong Kong Med J 2004; 10: 281-4

  32. Micheletti A, Hislop A, Lammers A, et al. Role of atrial septostomy in the treatment of children with pulmonary arterial hypertension. Heart published online 8 Nov 2005.doi: 10.1136/hrt.2005.077669

  33. Sandoval J, Rothman A, Pulido T. Atrial septostomy for pulmonary hypertension. Clin Chest Med 2001; 22: 547-560.

  34. Bristow MR, Zisman LS, Lances BD, et al. The pressure overloaded right ventricle in pulmonary hypertension. Chest 1998; 114 (Suppl): 101S-106S

  35. Barst RJ. Role of atrial septostomy in the treatment of pulmonary vascular disease. Thorax 2000; 55: 95-96

  36. Lehner A, Schulze-Neick I, Fischer M, et al. The Creation of an Interatrial Right-To-Left Shunt in Patients with Severe, Irreversible Pulmonary Hypertension: Rationale, Devices, Outcomes. Current Cardiology Reports (2019) 21: 31 https://doi.org/10.1007/s11886-019-1118-8

  37. Bristow MR, Zisman LS, Lances BD, et al. The pressure overloaded right ventricle in pulmonary hypertension. Chest 1998; 114 (Suppl): 101S-106S

  38. Ciarka A, Vachiery JL, Stoupel E, Velez-Roa S, Degaute JP, Naeije R, van de Borne P. Atrial septostomy and muscle sympathetic nerve activity in pulmonary arterial hypertension. Kardiol Pol 2006; 64: 5 (Suppl 1). P B29

  39. Espínola-Zavaleta N, Vargas-Barrón J, Tazar JI, et al. Echocardiographic evaluation of patients with pulmonary hypertension before and after atrial septostomy. Echocardiographic 1999; 16: 625

  40. Al Maluli H, DeStephan ChM, Alvarez RJ, Sandoval J. Atrial Septostomy: A Contemporary Review. Clin. Cardiol 2015; 38:6, 395–400




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