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J Heart Lung Transplant. 2013 Apr;32(4):381-7. doi: 10.1016/j.healun.2013.01.1049. Epub 2013 Feb 14.

Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical experience.

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1
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

Patients with severe pulmonary arterial hypertension (PAH) face significant morbidity and death as a consequence of progressive right heart failure. Surgical shunt placement between the left PA and descending aorta (Potts shunt) appears promising for PAH palliation in children; however, surgical mortality is likely to be unacceptably high in adults with PAH.

METHODS:

We describe a technique for transcatheter Potts shunt (TPS) creation by fluoroscopically guided retrograde needle perforation of the descending aorta at the site of apposition to the left PA to create a tract for deployment of a covered stent between these vessels. This covered stent-anchored by the vessel walls and surrounding tissue-serves as the shunt.

RESULTS:

TPS creation was considered in 7 patients and performed in 4. The procedure was technically successful in 3 patients; 1 patient died during the procedure as a result of uncontrolled hemothorax. One acute survivor, critically ill at the time of TPS creation, later died of comorbidities. The 2 mid-term survivors (follow-up of 10 and 4 months) are well at home, with symptomatic improvement and no late complications. The 3 candidate patients in whom the procedure was not performed died within 1 month of consideration, underscoring the tenuous nature of this population.

CONCLUSIONS:

TPS creation is feasible and may offer symptomatic relief to select patients with refractory PAH. Further study of this innovative approach is warranted.

PMID:
23415728
DOI:
10.1016/j.healun.2013.01.1049
[Indexed for MEDLINE]
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