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Efficacy of interatrial shunt devices: an opening window to acute pulmonary hypertensive crisis and chronic pulmonary arterial hypertension

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Abstract

The current study aimed to elucidate the efficacy of interatrial shunt device (IASD) for the treatment of acute pulmonary hypertensive crisis (PHC) and chronic pulmonary arterial hypertension (PAH). After establishing chronic PAH models using dehydrogenized monocrotaline (DHMCT), PAH dogs were implanted with IASDs (group A) or received no intervention (group B). One month later, DHMCT was injected again to establish an acute PHC. The prognosis, hemodynamics, ultrasound cardiography, electrocardiogram, and lung pathology of the dogs were observed. The baseline mean pulmonary arterial pressure increased from 12.70 ± 1.03 to 19.95 ± 1.75 mmHg and established a chronic PAH model 2 months after DHMCT injection (1.50 mg/kg). After an additional injection of DHMCT (1.50 mg/kg) in the chronic PAH model, acute PHC occurred. Mean PAP, sPAP, and pulmonary vascular resistance increased to 22.67 ± 1.80 mmHg, 35.70 ± 1.66 mmHg, and 12.50 ± 3.50 WOOD U, respectively. Cardiac output (CO) decreased to 1.31 ± 0.26 L/min, and the right-to-left shunt caused hypoxemia. The survival rates of the dogs with and those without IASD were 70.0% and 22.2% (P = 0.037), respectively. Six months after PHC, the CO between the dogs with and those without IASD were 1.44 ± 0.11 L/min and 1.18 ± 0.04 L/min (P = 0.028). The long-term survival rates were 50.0% and 22.2%, respectively (P = 0.21). IASD might be efficacious and beneficial for treating acute PHC and chronic PAH, as well as improving prognosis.

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References

  1. Hanff TC, Kaye DM, Hayward CS, Post MC, Malek F, Hasenfubeta G, Gustafsson F, Burkhoff D, Shah SJ, Litwin SE, Kahwash R, Hummel SL, Borlaug BA, Solomon SD, Lam C, Komtebedde J, Silvestry FE (2019) Assessment of predictors of left atrial volume response to a transcatheter interatrial shunt device (from the REDUCE LAP-HF Trial). Am J Cardiol 124(12):1912–1917

    Article  Google Scholar 

  2. Al MH, DeStephan CM, Alvarez RJ, Sandoval J (2015) Atrial septostomy: a contemporary review. Clin Cardiol 38(6):395–400

    Article  Google Scholar 

  3. Sandoval J, Gaspar J, Pena H, Santos LE, Cordova J, Del VK, Rodriguez A, Pulido T (2011) Effect of atrial septostomy on the survival of patients with severe pulmonary arterial hypertension. Eur Respir J 38(6):1343–1348

    Article  CAS  Google Scholar 

  4. Khan MS, Memon MM, Amin E, Yamani N, Khan SU, Figueredo VM, Deo S, Rich JD, Benza RL, Krasuski RA (2019) Use of balloon atrial septostomy in patients with advanced pulmonary arterial hypertension: a systematic review and meta-analysis. Chest 156(1):53–63

    Article  Google Scholar 

  5. Zierer A, Melby SJ, Voeller RK, Moon MR (2009) Interatrial shunt for chronic pulmonary hypertension: differential impact of low-flow vs high-flow shunting. Am J Physiol Heart Circ Physiol 296(3):H639–H644

    Article  CAS  Google Scholar 

  6. Sandoval J, Gaspar J, Pulido T, Bautista E, Martinez-Guerra ML, Zeballos M, Palomar A, Gomez A (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

    Article  CAS  Google Scholar 

  7. Feldman T, Mauri L, Kahwash R, Litwin S, Ricciardi MJ, van der Harst P, Penicka M, Fail PS, Kaye DM, Petrie MC, Basuray A, Hummel SL, Forde-McLean R, Nielsen CD, Lilly S, Massaro JM, Burkhoff D, Shah SJ (2018) Transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction (REDUCE LAP-HF I [reduce elevated left atrial pressure in patients with heart failure]): a phase 2, randomized sham-controlled trial. Circulation 137(4):364–375

    Article  Google Scholar 

  8. Rajeshkumar R, Pavithran S, Sivakumar K, Vettukattil JJ (2017) 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 90(7):1145–1153. https://doi.org/10.1002/ccd.27233

    Article  PubMed  Google Scholar 

  9. Gorbachevsky SV, Shmalts AA, Dadabaev GM, Nishonov NA, Pursanov MG, Shvartz VA, Zaets SB (2020) Outcomes of atrioseptostomy with stenting in patients with pulmonary arterial hypertension from a large single-institution cohort. Diagnostics 10(9):725

    Article  Google Scholar 

  10. O’Loughlin AJ, Keogh A, Muller DW (2006) Insertion of a fenestrated Amplatzer atrial septostomy device for severe pulmonary hypertension. Heart Lung Circ 15(4):275–277

    Article  Google Scholar 

  11. Flamm MD, Cohn KE, Hancock EW (1969) Measurement of systemic cardiac output at rest and exercise in patients with atrial septal defect. Am J Cardiol 23(2):258–265

    Article  CAS  Google Scholar 

  12. Kim HJ, Yoo HY (2016) Hypoxic pulmonary vasoconstriction and vascular contractility in monocrotaline-induced pulmonary arterial hypertensive rats. Korean J Physiol Pharmacol 20(6):641–647

    Article  CAS  Google Scholar 

  13. Allen J, Peterson N, Barrett K, Llamas A (2020) Graded balloon atrial septostomy for palliation of congenital pulmonary hypertension in a dog: a case report. J Vet Intern Med 34(1):283–288

    Article  Google Scholar 

  14. Zhou L, Zhang J, Jiang XM, **e DJ, Wang JS, Li L, Li B, Wang ZM, Rothman A, Lawrie A, Chen SL (2015) Pulmonary artery denervation attenuates pulmonary arterial remodeling in dogs with pulmonary arterial hypertension induced by dehydrogenized monocrotaline. JACC Cardiovasc Interv 8(15):2013–2023

    Article  Google Scholar 

  15. Katoh Y, Nakajima Y, Yamagishi M, Mizobe T (2003) Infection-induced pulmonary hypertension crisis after Rastelli procedure. Paediatr Anaesth 13(5):461–463

    Article  Google Scholar 

  16. Lehner A, Schulze-Neick I, Fischer M, Fernandez-Rodriguez S, Ulrich S, Haas NA, Jakob A (2019) The creation of an interatrial right-to-left shunt in patients with severe, irreversible pulmonary hypertension: rationale, devices, outcomes. Curr Cardiol Rep 21(5):31

    Article  Google Scholar 

  17. Law MA, Grifka RG, Mullins CE, Nihill MR (2007) Atrial septostomy improves survival in select patients with pulmonary hypertension. Am Heart J 153(5):779–784

    Article  Google Scholar 

  18. Althoff TF, Knebel F, Panda A, McArdle J, Gliech V, Franke I, Witt C, Baumann G, Borges AC (2008) Long-term follow-up of a fenestrated Amplatzer atrial septal occluder in pulmonary arterial hypertension. Chest 133(1):283–285

    Article  Google Scholar 

  19. Fraisse A, Chetaille P, Amin Z, Rouault F, Humbert M (2006) Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension. Pediatr Cardiol 27(6):759–762

    Article  Google Scholar 

  20. Zijlstra W, Douwes JM, Rosenzweig EB, Schokker S, Krishnan U, Roofthooft MTR, Miller-Reed K, Hillege HL, Ivy DD, Berger RMF (2014) Survival differences in pediatric pulmonary arterial hypertension: clues to a better understanding of outcome and optimal treatment strategies. J Am Coll Cardiol 63(20):2159–2169

    Article  Google Scholar 

  21. Arvanitaki A, Giannakoulas G, Baumgartner H, Lammers AE (2020) Eisenmenger syndrome: diagnosis, prognosis and clinical management. Heart 106(21):1638–1645

    Article  CAS  Google Scholar 

  22. Manes A, Palazzini M, Leci E, Bacchi RM, Branzi A, Galie N (2014) Current era survival of patients with pulmonary arterial hypertension associated with congenital heart disease: a comparison between clinical subgroups. Eur Heart J 35(11):716–724

    Article  Google Scholar 

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Acknowledgements

The animal experiment is conducted in Laboratory Animal Center of Zhongshan Hospital affiliated to Fudan University. I would like to express my gratitude to my co-workers and all the staff workers during the animal experiment for their help and opinions.

Funding

This study was funded by Shanghai Association for Science and Technology (Grant No. 14ZR1406700).

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Authors and Affiliations

  1. Division of Cardiology, Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital Affiliated to Fudan University, No 180, Fenglin Road, Shanghai, 200032, China

    Lifan Yang, Lei Zhang, Shasha Chen, Mingfei Li, Yuliang Long, Wei Li, Qi **, Lihua Guan, Daxin Zhou & Junbo Ge

  2. Shanghai Xuhui District Central Hospital, Shanghai, China

    Lifan Yang

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  1. Lifan Yang
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Correspondence to Lihua Guan or Daxin Zhou.

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Yang, L., Zhang, L., Chen, S. et al. Efficacy of interatrial shunt devices: an opening window to acute pulmonary hypertensive crisis and chronic pulmonary arterial hypertension. J Thromb Thrombolysis 54, 123–131 (2022). https://doi.org/10.1007/s11239-022-02635-3

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