Graded balloon atrial septostomy in severe XXXX .

@entity1 @entity26 @entity712 @entity120
BACKGROUND: The prognosis of @entity1 with severe @entity120 is poor. The role of balloon atrial septostomy as a palliative procedure in these @entity1 is not well defined. We retrospectively analyzed our data regarding the safety, clinical outcome and survival benefit of graded balloon atrial septostomy in @entity1 with severe @entity120 . METHODS AND RESULTS: Eleven @entity1 (7 males), aged 6 to 30 years (mean age 16.2+/-8.9 years), with severe @entity120 (mean pulmonary artery pressure of 76+/-16.9 mmHg) and refractory congestive @entity712 and/or recurrent syncope underwent balloon atrial septostomy. Graded balloon dilatation under echocardiographic guidance and arterial @entity26 saturation monitoring was done in all the @entity1 . Procedure-related mortality was 18.2%. Significant acute hemodynamic improvement was seen in the survivors (pre-balloon atrial septostomy cardiac index 1.88+/-0.48 L/min/m2; post-balloon atrial septostomy cardiac index 2.18+/-0.37 L/min/m2, p<0.009). @entity1 were followed up for a mean period of 20.3 months after the procedure (range: 3 months-5 years). There was functional improvement and increased exercise tolerance in all the @entity1 for a mean follow-up period of 14.6 months (NYHA functional class 3.62+/-0.69 to 2+/-0.50). The estimated probability of survival in this cohort at 1 year was only 48%; but 7 of 8 @entity1 (87%) who survived the procedure were alive at 1 year. CONCLUSION: We conclude that balloon atrial septostomy improves clinical status, hemodynamic variables and possibly also improves survival in selected @entity1 with severe @entity120 . It remains a definite palliative option for refractory @entity120 . However, the procedure-related risks are high in very sick @entity1 and, therefore, balloon atrial septostomy may be advocated early in the course of the disease.
