AFR implantation can provide symptom relief in PAH patients with recurrent syncope and RV failure

Introduction: Pulmonary Arterial Hypertension (PAH), is a progressive disease with a high rate of morbidity and mortality. Despite significant advances in pharmacological therapies, many patients will continue to deteriorate with progressive symptoms of right ventricular failure. Creating a right to left shunt through the interatrial septum can decompress right sided chambers, improve left ventricular filling and help maintain cardiac output, providing symptom relief and preventing syncope. Atrial Flow Regulator (AFR) device can maintain a permanent shunt with a predetermined diameter and help hemodynamics in PAH patients.

Method and results: Eight PAH patients (mean age: 35.6) with recurrent syncope and right sided heart failure despite pharmacological treatment were enrolled and AFR implanted under fluoroscopy with help of transesophageal echocardiography. Patients were followed for 6 months. One patient deteriorated after the procedure and underwent VA ECMO implantation and Lung transplantation. AFR was associated with stopping syncope, improving 6MWT (302±33 to 380±32 meters) and improving cardiac index (2.1± 0.43 to 2.7 ±0.5) which maintained to 6 months.

Conclusion: AFR implantation can provide symptom relief in PAH patients with recurrent syncope and RV failure. It maintained patency during follow-up and improved symptoms ,6-MWD and cardiac index.