NEW YORK (Reuters Health) - Creating a right-to-left shunt at the atrial level by balloon septostomy improves measures of right heart failure in patients with pulmonary hypertension (PH), according to a report in the April issue of Chest.

Balloon atrial septostomy (BAS) "may be used as a bridge for transplantation but also for patients who are not eligible for lung transplantation (for example because of age, coexisting diseases) and in whom all forms of medical therapy expired," Dr. Marcin Kurzyna from the National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland told Reuters Health.

Dr. Kurzyna and colleagues report on 14 BAS procedures in 11 patients with refractory right heart failure resulting from pulmonary hypertension.

All patients survived the procedure, the authors report, and there were no serious complications associated with the BAS.

The cardiac index increased significantly after the BAS procedure, the results indicate, though pulmonary artery and atrial pressures did not change. Pulmonary vascular resistance increased directly after the procedure, the researchers note, and this increase correlated inversely with the value of mixed venous blood oxygen saturation.

The mean WHO functional class improved from 3.2 to 2.6 at 1 month after the BAS procedure, the investigators say.

Six patients experienced spontaneous closure with recurrence of symptoms, and three of these patients underwent successful repeat BAS.

Cumulative survival was 64% at 6 and 12 months, which did not differ from predicted mean survival rates, the report indicates.

"BAS should not be abandoned despite development of new drugs for PH," Dr. Kurzyna said. "Finding the optimal time and optimal population of patients is key-point of further research."

Dr. Kurzyna added: "We are going to start an open-label study focused on an earlier intervention hoping it allows creating of larger hole in the interatrial septum (smaller pressure gradient between right atrium and left atrium) and to decrease the rate of spontaneous closure."