Percutaneous Atrial Septostomy with Modified Butterfly Stent and Intracardiac Echocardiographic Guidance in a Patient with Syncope and Refractory Pulmonary Arterial Hypertension

PurposeSyncope is associated with poor prognosis in patients with pulmonary hypertension. Atrial septostomy improves cardiac index and functional class in appropriately selected patients with pulmonary hypertension, and has been shown to improve syncope. One of the major challenges to its effectiveness is maintaining septostomy patency. We report the case of percutaneous deployment of a modified peripheral stent to create an atrial septostomy in a man with severe pulmonary hypertension and syncope, initially intolerant of medical therapy.ProceduresPercutaneous butterfly stent deployment across the interatrial septum using intracardiac echocardiography and fluoroscopy.FindingsThe patient improved in all clinical parameters (BNP, six-minute walk test, dyspnoea score), and was subsequently able to tolerate targeted pulmonary hypertension therapies.Principal conclusionsAtrial septostomy using butterfly stents to maintain patency may play a role in the treatment of patients with advanced pulmonary hypertension who do not respond to targeted therapy.