Interatrial shunt for chronic pulmonary hypertension: differential impact of low-flow vs. high-flow shunting.

American Journal of Physiology. Heart and Circulatory Physiology
Andreas ZiererMarc R Moon

Abstract

The purpose of the present study was to determine for the first time the qualitative and quantitative impact of varying degrees of interatrial shunting on right heart dynamics and systemic perfusion in subjects with chronic pulmonary hypertension (CPH). Eight dogs underwent 3 mo of progressive pulmonary artery banding, following which right atrial and ventricular end-systolic and end-diastolic pressure-volume relations were calculated using conductance catheters. An 8-mm shunt prosthesis was inserted between the superior vena cava and left atrium, yielding a controlled model of atrial septostomy. Data were obtained 1) preshunt or "CPH"; 2) "Low-Flow" shunt; and 3) "High-Flow" shunt (occluding superior vena cava forcing all flow through the shunt). With progressive shunting, right ventricular pressure fell from 72 +/- 19 mmHg (CPH) to 54 +/- 17 mmHg (Low-Flow) and 47 +/- 17 mmHg (High-Flow) (P < 0.001). Cardiac output increased from 1.5 +/- 0.3 l/min at CPH to 1.8 +/- 0.4 l/min at Low-Flow (286 +/- 105 ml/min, 15% of cardiac output; P < 0.001), but returned to 1.6 +/- 0.3 l/min at High-Flow (466 +/- 172 ml/min, 29% of cardiac output; P = 0.008 vs. Low-Flow, P = 0.21 vs. CPH). There was a modest rise in systemic oxygen delivery f...Continue Reading

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Citations

Sep 20, 2011·American Journal of Physiology. Heart and Circulatory Physiology·Rochus K VoellerMarc R Moon
Apr 19, 2012·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Timo WeimarMarc R Moon
Oct 25, 2017·Children·Shilpa Shah, Jacqueline R Szmuszkovicz
Jan 5, 2018·Interactive Cardiovascular and Thoracic Surgery·Tom VerbelenBart Meyns
Apr 24, 2012·American Journal of Physiology. Heart and Circulatory Physiology·Yvette KoekenTammo Delhaas
Jun 28, 2011·Expert Review of Respiratory Medicine·Astrid E LammersGerhard-Paul Diller

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