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Editorials |

Atrial Septostomy: Why We Still Need It

Victor Tapson, MD, FCCP
Author and Funding Information

Affiliations: Duke University Medical Center Durham, NC ,  Dr. Tapson is Professor of Medicine, Pulmonary Allergy and Critical Care, Department of Medicine, Duke University Medical Center.

Correspondence to: Victor Tapson, MD, FCCP, Pulmonary Allergy and Critical Care, Department of Medicine, Duke University Medical Center, Durham, NC 27710; e-mail: tapso001@mc.duke.edu



Chest. 2007;131(4):947-948. doi:10.1378/chest.07-0335
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Untreated idiopathic pulmonary arterial hypertension (PAH) is characterized by a progressive elevation of pulmonary artery pressure, followed by worsening right ventricular failure and ultimately death.1 With the most aggressive medical approaches (continuous IV prostacyclin therapy), survival is only approximately 63% at 3 years.23 Patients with idiopathic PAH and a patent foramen ovale (PFO) appear to live longer than those without a PFO.4 Individuals with Eisenmenger syndrome (anatomic right-to-left shunt) have a better prognosis than those with PAH without a shunt, based on a slowly progressive increase in pressure and gradual evolution of right ventricular hypertrophy that enable the ventricle to cope with very high pressures.5 Creation of an interatrial communication has been shown to preserve systemic output by decompressing the dysfunctional right ventricle, offering temporary clinical benefit to very ill patients with idiopathic PAH in whom therapy is failing.69

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