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2004, Number S1

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Rev Inst Nal Enf Resp Mex 2004; 17 (S1)

Atrial septostomy, lung transplantation and thromboendarterectomy for pulmonary hypertension

Santibañez-Salgado A, Jasso VR, Olmos-Zúñiga R, Pérez CD, Rey RA, Santillán DP, Villalba CJ

Language: Spanish
References: 59
Page: 62-70
PDF size: 82.24 Kb.


ABSTRACT

Primary pulmonary arterial hypertension (PPH) follows a rapid clinical deterioration and has high mortality. In spite of progress in medical treatment, lung transplantation or heart-lung transplantation is the best therapeutic option, and atrial septostomy is indicated when there is not other therapeutic option or as a step for lung transplant.
Atrial septostomy is a palliative treatment for patients with PPH. The haemodynamic effects are: increase of cardiac output, cardiac index, and systemic oxygen transport; it decreases oxygen saturation and this can promote right ventricle ischemia, worsening right ventricular failure; and diminishes right atrial pressure, improving systemic venous congestion, ascitis and peripheral oedema.
Unilateral lung transplantation, bilateral lung transplantation and heart-lung transplantation are the best treatment for patients with PPH. A patient is considered ready for transplantation when he has a poor life expectancy and life quality but he is a good physical condition; he could survive the surgical procedure.
Thromboembolic pulmonary hypertension has very bad prognosis, proportional to the degree of pulmo nary hypertension. Thromboendarterectomy is indicated with pulmonary vascular resistance › 300dinas/s/cm-5. y ‹ 500dinas/s/cm-5. Most of the patients improve clinical and hemodynamically after the surgical procedure, normalizing pulmonary pressure and pulmonary vascular resistance, 62% of the patients has a normal life.


REFERENCES

  1. Gaines SP, Rubin LJ. Primary Pulmonary Hypertension. Lancet 1998;352:719-725.

  2. D’Alonzo GE, Barst RJ, Ayres SM, Berfofsky EH, Brundadge BH, Detre KM, et al. Survival in Patients with Primary Pulmonary Hypertension. Results of a National Prospective Study. Ann Intern Med 1991;115:343-349.

  3. Rich S, Kaufmann E, Levy PS. The Effect of High Doses of Calcium-channel Blockers on Survival in Primary Pulmonary Hypertension. N Engl J Med 1992;327:76-81.

  4. Barst RJ, Rubin LW, Long WA, Mc Goon MD, Richs S, Badesch DB, et al. A Comparison of Continuous Intravenous Espoprostenol (prostacyclin) with Conventional Therapy for Primary Pulmonary Hypertension. N Engl J Med 1996;334:296-301.

  5. Rich S. Primary Pulmonary Hypertension. Prog Cardiovasc Dis 1998;31:205-238.

  6. MacLaughlin VV, Genthner DE, Panella MM, Richs S, et al. Reduction in Pulmonary vascular Resistance with Long-term Epoprostenol (prostacyclin) Therapy in Primary Pulmonary Hypertension. N Engl J Med 1998;338:273-277.

  7. Miyamoto S, Nagaya N, Satoh T, Kyotani T, Sakamaki F, Fujita M, et al. Clinical Correlates and Prognostic Significance of Six-minute Walk Test in Patients with Primary Pulmonary Hypertension. Am J Respir Crit Care Med 2000;161:487-492.

  8. Rozkovec A, Montanes P, Oakley CM. Factors that Influence the Outcome of Primary Pulmonary Hypertension. Br Heart J 1986;55:449-458.

  9. Glanville AR, Burke CM, Theodore J, Baldwin JC, Robin ED. Lenght of Survival in Patients Referred for Heart-lung Transplantation. Chest 1987;91:675-681.

  10. Rich S, Lam W. Atrial Septostomy as Palliative Therapy for Refractory Primary Pulmonary Hypertension. Am J Cardiol 1983;51:1580-1581.

  11. Hausknecht MJ, Sims RE, Nihill MR, Cashion WR. Successful Palliation of Primary Pulmonary Hypertension by Atrial Septostomy. Am J Cardiol 1990;65:1045-1046.

  12. Nihill MR, O’Laughlin MP, Mullins CE. Effects of Atrial Septostomy in Patients with Terminal Cor Pulmonale due to Pulmonary Vascular Disease. Cathet Cardiovasc Diagn 1991;24:166-172.

  13. Thanopoulos BD, Georgakopoulos D, Tsaousis GS, Simenunovic S. Percutaneous Balloon Dilatation of the Atrial Septum: Immediate and Midterm Results. Heart 1996;76:502-504.

  14. Rothman A, Sklansky MS, Lucas VW, Kashani IA, Shaughnessy RD, Channick RN, et al. Atrial Septostomy as a Bridge to Lung Transplantation in Patients with Severe Pulmonary Hypertension. Am J Cardiol 1999;84:682-686.

  15. Sandoval J, Rothman A, Pulido T. Atrial Septostomy for Pulmonary Hypertension. Clin Chest Med 2001;22: 547-560.

  16. Rothman A, Beltran D, Kriett JM, Smith, C, Wolf P, Jamieson SW. Graded Ballon Dilatation Atrial Septostomy as a Bridge to Transplantation in Primary Pulmonary Hypertension. Am Heart J 1993;125:1763-1768.

  17. Kerstein D, Levy PS, Hsu DT, Hordof AJ, Gersony WM, Barst RJ. Blade Balloon Atrial Septostomy in Patients with Severe Primary Pulmonary Hypertension. Circulation 1995;91:2028-2035.

  18. 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;80:369-371.

  19. Austen WG, Morrow AG, Berry WB. Experimental Studies of the Surgical Treatment of Primary Pulmonary Hypertension. J Thorac Cardiovasc Surg 1964;48:448-455.

  20. Kawaguchi AT, Kawashima Y, Ishibashi-Ueda H, Yanase M, Marakami T, Yagihara T, et al. Right-to-left Interatrial Shunt in Rats with Progressive Pulmonary Hypertension. J Thorac Cardiovasc Surg 1993;106:1072-1080.

  21. Vlahakes GJ, Turley K, Hoffman JIE. The Patophysiology of Failure in Acute Right Ventricular Hypertension: Hemodinamic and Biochemical Correlations. Circulation 1981;63:87-95.

  22. Usseti Gil P, Varela de Ugarte A. Alternativas quirúrgicas en el tratamiento de la hipertensión pulmonar grave. Arch Bronconeumol 2002;38(1 Supl ):33S-38S.

  23. Wildevuur CRH, Benfield JR. A Review of 23 Human Lung Transplantation by 20 Surgeons. Ann Thorac Surg 1970;9:489-515.

  24. Reitz BA, Wallwork JL, Hunt SA, Pennock Jl, Billingham ME, Oyer PE, et al. Heart-lung Transplantation: Successful Therapy for Patients with Pulmonary Vascular Disease. N Engl J Med 1982;306:557-564.

  25. Cooper JD, Ginsberg RJ, Goldberg M. Unilateral Lung Transplantation for Pulmonary Fibrosis. N Engl J Med 1986;314:1140-1144.

  26. Trulock EP. Lung Transplantation for Primary Pulmonary Hypertension. Clin Chest Med 2001;22:583-93.

  27. Gammie JS, Keenan RJ, Pham SM, McGrath MF, Hattler BG, Khoshbin E. Single Versus Double Lung Transplantation for PHT. J Thorac Cardiovasc Surg 1998;115:397-403.

  28. Whyte RI, Robbins RC, Altinger J, Barlow CW, Doyle R, Theodore J, Reitz BA. Heart-lung Transplantation for Primary PHT. Ann Thorac Surg 1999;67:937-942.

  29. Hardesty RL, Griffith BP. Procurement for Combined Heart-lung Transplantation. J Thorac Cardiovasc Surg 1984;89:795-799.

  30. Mendeloff EN, Meyers BF, Sundt TM, Guthrie TJ, Sweet SC, Shapiro S, et al. Lung Transplantation for Pulmonary Vascular Disease. Ann Thorac Surg 2002;73:209-219.

  31. Conte JV, Borja MJ, Patel CB, Yang SC, Jhaveri RM, Orcrus JB, et al. Lung Transplantation for Primary and Secundary Hypertension. Ann Thorac Surg 2001;72:1673-1679.

  32. Brenot F. Primary Pulmonary Hypertension. Case Series from France. Chest 1994;105:33S-37S.

  33. Oakley CW. Primary Pulmonary Hypertension. Case Series from the United Kingdom. Chest 1994; 105:29S-33S.

  34. Mikhail G, Al-Kattan K, Banre N, Mitchell A, Radley-Smith R, Khagani A, Vacoub M. Long Term Results of Heart-lung Transplantation for PHT. Transplant Proc 1997;29:633-637.

  35. Pielsticker EJ, Martínez FJ, Rubenfire M. Lung and Heart-lung Transplant Practice in Pulmonary Hypertension Centers. J Heart-Lung Transplant 2001;20: 1297-1304.

  36. Hosenpund JD, Bennet LE, Keck BM, Fiol B, Boucek MM, Novick RJ. The Registry of the International Society for Heart and Lung Transplant: Sixteenth Official Report-1999. J Heart Lung Transplant 1999;18:611-626.

  37. International Guidelines for Selection of Lung Transplant Candidates. Am J Respir Crit Care 1998;158:335-340.

  38. DeMeester J, Smits JM, Persijn GG, Haverich A. Listing for Lung Transplantation: Life Expectancy and Transplant Effect, Stratified by Type of End-stage Lung Disease, the Eurotransplant Experience. J Heart Lung Transplant 2001;20:518-524.

  39. Trulock EP. Lung Transplantation: State of the Art. Am J Respir Crit Care 1998;158:335-340.

  40. Aeba R, Stout J, Francalancia N, Keenan RJ, Duncan AJ, Yousem SA. Aspects of Lung Transplantation that Contribute to Increased Severity of Pneumonia. J Thorac Cardiovasc Surg 1993; 106:449-457.

  41. Benotti JR, Ockene IS, Alpert JS, Dalen JE. The Clinical Profile of Unresolved Pulmonary Embolism. Chest 1983;84:669-678.

  42. Dalen JE, Alpert JS. Natural History of Pulmonary Embolism. Prog Cardiovasc Dis 1975;17:259-270.

  43. Olman MA, Marsh JJ, Lange IM, Moser KM, Binder BR, Schleef RR. Endogenous Fybrinolitic System in Chronic Large Vessel Thromboembolic Pulmonary Hypertension. Circulation 1992;86:1241-1248.

  44. Jamieson SW, Auger WR, Fedullo PF, Channick RN, Krtiett JM, Tarazi RY, et al. Experience and Results with 150 Pulmonary Thromboendarterectomy Operations over a 29-month Period. J Thorac Cardiovasc Surg 1993;106:116-127.

  45. Moser KM, Auger WR, Fedullo PF. Chronic Major-vessel Thromboembolic Pulmonary Hypertension. Circulation 1990;81:1735-1743.

  46. Archibald CJ, Auger WR, Fedullo PF, Channick RN, Kerr KM, Jamieson SW, et al. Long-term Outcome After Pulmonary Thromboendarterectomy. Am J Respir Crit Care Med 1999;160:523-528.

  47. Dantzker DR, Bower JS. Partial Reversibility of Chronic Pulmonary Hypertension Caused by Pulmonary Thromboembolic Disease. Am Rev Respir Dis 1981;124: 129-131.

  48. Dash H, Ballentine N, Zelis R. Vasodilators Ineffective in Secondary Pulmonary Hypertension. N Engl J Med 1980;303:1062-1063.

  49. Ussetti Gil P, Varela de Ugarte A. Alternativas quirúrgicas en el tratamiento de la hipertensión pulmonar grave. Arch Bronconeumol 2002;38(Supl 1):33-38.

  50. Cabrol C. Traitement Chirurgical de l’embolie Pulmonaire. Coeur 1974;V:477-489.

  51. Cabrol C, Cabrol A, Acar J, Gandjnakhch I, Guiraudon G, Laughlin L, et al. Surgical Correction of Chronic Postembolia Obstructions of the Pulmonary Arteries. J Thorac Cardiovasc Surg 1978;76: 620-628.

  52. Boucher H, Protar M, Bertein J. Aneurysme de la Branche Droite de l’artere Pulmonaire par Embol Latent Post-phlebitique. J Franc Med Chir Thorac 1951; 5:421-427.

  53. Hollister LE, Cull VL. The Syndrome of Chronic Thromboembolism of the Major Pulmonary Arteries. Am J Med 1956;21:312-320.

  54. Hurwitt ES, Schein CJ, Rifkin H, Lebendiger A. A Surgical Approach to the Problem of Chronic Pulmonary Artery Obstruction due to Thrombosis or Stenosis. Ann Surg 1958;147:157-165.

  55. Allison PR, Dunnill MS, Marshall R. Pulmonary Embolism. Thorax 1960;15:273-283.

  56. Snyder WA, Kent DC, Baish BF. Successful Endarterectomy of Chronically Occluded Pulmonary Artery. J Thorac Cardiovasc Surg 1963;45:482-489.

  57. Castleman B, McNeely BU, Scannell G. Case Records of the Massachusetts General Hospital: case 32-1964. N Engl J Med 1964;271:40-50.

  58. Bergin CJ, Sirlin C, Deutsh R, Fedulla P, Hauschildt J, Huynh T, et al. Predictors of Patient Response to Pulmonary Thromboendarterectomy. AJR Am J Roentgenol 2000;174:509-15.

  59. Dartevelle P, Fadel E, Chapelier A, Macchiarini P, Cerrina J, Parquin F. Angyoscopyc Video-asisted Pulmonary Endarterectomy for Post-embolic Pulmonary Hypertension. Eur J Cardiothorac Surg 1999;16:38-43.




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