Atrial septostomy in a patient with severe pulmonary hypertension and hypoxia: A therapeutic dilemma

Abstract

Atrial septostomy may be considered in individuals with severe pulmonary arterial hypertension and right heart failure, despite maximal medical therapy, as a palliative procedure or bridge to transplant. Low oxygen saturation is a relative contraindication to atrial septostomy. However, the majority of the patients with severe refractory pulmonary arterial hypertension for whom atrial septostomy may be indicated have a certain degree of hypoxia. We describe a case of an adult patient with severe pulmonary hypertension and hypoxia, who presented with syncope from reduced left ventricular filling. She subsequently underwent successful atrial septostomy. We extensively discuss the role of atrial septostomy and the management conundrum in such patients.