ABSTRACT
Survival in pulmonary arterial hypertension (PAH) is highly dependent on the functional status of the right ventricle. Hemodynamic variables that reflect right ventricular (RV) dysfunction, such as a low cardiac output (CO) and, in particular, elevated mean rightatrial pressures (mRAPs) are associated with poor prognosis (1). The main objectives of the contemporary management of PAH are (i) to alleviate pulmonary microvascular obstruction as the primary objective and (ii) to alleviate right ventricular failure (RVF) as a secondary goal. Medical treatments for PAH are reviewed in other chapters of this book. There is no question that pharmacological interventions such as long-term intravenous infusion of prostacyclin and, more recently, other prostacyclin analogues, endothelin-receptor antagonists, and phosphodiesterase-5 inhibitors have improved the quality of life and survival of patients with PAH (2,3). Despite all these interventions, however, RVF may progress or reoccur in some patients (4). This chapter reviews the role of atrial septostomy (AS), an intervention specifically oriented to the relief of RVF, in the treatment scheme of PAH.
