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Balloon atrial septostomy and transition of subcutaneous to intravenous prostacyclin infusion for rescuing advanced right heart failure in idiopathic pulmonary arterial hypertension: a case report.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-5.EH

Abstract

Background

Intravenous (IV) prostacyclin analogues infusion and balloon atrial septostomy (BAS) are two important treatment options for managing advanced right heart failure in patients with idiopathic pulmonary arterial hypertension (IPAH). References and protocols are rare for dose titrations and transitions between subcutaneous and IV prostacyclin in functional Class IV IPAH patients. Balloon atrial septostomy is rarely done in very few expert centres.

Case summary

A young female with IPAH who had received maximal medication including subcutaneous prostacyclin analogues injection was admitted due to advanced right heart failure. She received ascites drainage twice. Later, we directly switched the administration route of prostacyclin from subcutaneous to IV at a ratio of 1:1 instantly. Such rapid conversion led her into a state of profound hypotension and drowsy consciousness, which was resolved after escalating IV inotropics and reducing prostacyclin dosage. Five days later, she received BAS under the guidance of intracardiac echocardiography. Her urine output increased and dyspnoea improved gradually. Six months later, clinical worsening happened again with increase of ascites and dyspnoea. She underwent 2nd and 3rd session of graded BAS with relief of symptoms again. She received permanent transition to IV prostacyclin analogues infusions via a peripherally inserted central catheter after three sessions of BAS.

Discussion

Balloon atrial septostomy is effective in stabilizing the critical right heart failure in IPAH patients but should be intended as a bridge to lung transplant procedure. Transition from subcutaneous to IV prostacyclin is helpful but needs to be titrated in proper aliquots and time intervals to avoid abrupt haemodynamic changes.

Authors+Show Affiliations

Cardiovascular Center, Taichung Veterans General Hospital, No. 1650. Sec. 4, Taiwan Boulevard, Taichung 40705, Taiwan. Department of Medicine, School of Medicine, National Yang Ming University, No. 155, Sec. 2, Linong St. Taipei 11221, Taiwan.Cardiovascular Center, Taichung Veterans General Hospital, No. 1650. Sec. 4, Taiwan Boulevard, Taichung 40705, Taiwan. Center for Pulmonary Hypertension and Pulmonary Vascular Disease, School of Medicine and the Affiliated Hospital, China Medical University, Critical Care Center Building 15F, No. 2, Xueshi Road, North District, Taichung 40447, Taiwan.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617499

Citation

Liang, Kae-Woei, and Kuo-Yang Wang. "Balloon Atrial Septostomy and Transition of Subcutaneous to Intravenous Prostacyclin Infusion for Rescuing Advanced Right Heart Failure in Idiopathic Pulmonary Arterial Hypertension: a Case Report." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-5.
Liang KW, Wang KY. Balloon atrial septostomy and transition of subcutaneous to intravenous prostacyclin infusion for rescuing advanced right heart failure in idiopathic pulmonary arterial hypertension: a case report. Eur Heart J Case Rep. 2020;4(3):1-5.
Liang, K. W., & Wang, K. Y. (2020). Balloon atrial septostomy and transition of subcutaneous to intravenous prostacyclin infusion for rescuing advanced right heart failure in idiopathic pulmonary arterial hypertension: a case report. European Heart Journal. Case Reports, 4(3), 1-5. https://doi.org/10.1093/ehjcr/ytaa052
Liang KW, Wang KY. Balloon Atrial Septostomy and Transition of Subcutaneous to Intravenous Prostacyclin Infusion for Rescuing Advanced Right Heart Failure in Idiopathic Pulmonary Arterial Hypertension: a Case Report. Eur Heart J Case Rep. 2020;4(3):1-5. PubMed PMID: 32617499.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Balloon atrial septostomy and transition of subcutaneous to intravenous prostacyclin infusion for rescuing advanced right heart failure in idiopathic pulmonary arterial hypertension: a case report. AU - Liang,Kae-Woei, AU - Wang,Kuo-Yang, Y1 - 2020/05/03/ PY - 2019/10/26/received PY - 2019/11/19/revised PY - 2020/02/12/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Prostacyclin analogues KW - Balloon atrial septostomy KW - Case report KW - Idiopathic pulmonary arterial hypertension KW - Intracardiac echocardiography SP - 1 EP - 5 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - Background: Intravenous (IV) prostacyclin analogues infusion and balloon atrial septostomy (BAS) are two important treatment options for managing advanced right heart failure in patients with idiopathic pulmonary arterial hypertension (IPAH). References and protocols are rare for dose titrations and transitions between subcutaneous and IV prostacyclin in functional Class IV IPAH patients. Balloon atrial septostomy is rarely done in very few expert centres. Case summary: A young female with IPAH who had received maximal medication including subcutaneous prostacyclin analogues injection was admitted due to advanced right heart failure. She received ascites drainage twice. Later, we directly switched the administration route of prostacyclin from subcutaneous to IV at a ratio of 1:1 instantly. Such rapid conversion led her into a state of profound hypotension and drowsy consciousness, which was resolved after escalating IV inotropics and reducing prostacyclin dosage. Five days later, she received BAS under the guidance of intracardiac echocardiography. Her urine output increased and dyspnoea improved gradually. Six months later, clinical worsening happened again with increase of ascites and dyspnoea. She underwent 2nd and 3rd session of graded BAS with relief of symptoms again. She received permanent transition to IV prostacyclin analogues infusions via a peripherally inserted central catheter after three sessions of BAS. Discussion: Balloon atrial septostomy is effective in stabilizing the critical right heart failure in IPAH patients but should be intended as a bridge to lung transplant procedure. Transition from subcutaneous to IV prostacyclin is helpful but needs to be titrated in proper aliquots and time intervals to avoid abrupt haemodynamic changes. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617499/Balloon_atrial_septostomy_and_transition_of_subcutaneous_to_intravenous_prostacyclin_infusion_for_rescuing_advanced_right_heart_failure_in_idiopathic_pulmonary_arterial_hypertension:_a_case_report DB - PRIME DP - Unbound Medicine ER -
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