Application of interatrial shunt device in patients with severe pulmonary hypertension_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Shuna ¹ , SHANG Xiaoke ² , ZHANG Changdong ² , YUAN Yuan ¹ , ZHI Ying ¹ , HE Yan ¹ ,  HUANG Kai ^1,3

1. Cardiovascular Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, P. R. China;
2. Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 432300, P. R. China;
3. Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 432300, P. R. China;

Corresponding?author：

HUANG Kai, Email: huangkai1@hust.edu.cn

Keywords：

Pulmonary arterial hypertension; interatrial shunt device; atrial septostomy; systemic oxygen transport; review

DOI：

10.7507/1007-4848.202108108

Video：

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Abstract Full text Figures/Tables Video References Cited by

Pulmonary arterial hypertension (PAH) is a severe, progressive disease leading to right ventricular failure and finally death. Lung transplantation is recommended for PAH patients who do not respond to targeted drug combination therapy or World Health Organization functional class (WHO FC) Ⅲ or Ⅳ. However, only 3% of PAH patients can recieve the lung transplantation. A novel implantable interatrial shunt device (ISD) can create a relatively fixed right-to-left shunt established by balloon atrial septostomy (BAS). The device may decompress the right sided chambers, facilitate left heart filling, improve organ perfusion and reduce the likelihood of syncope, acute pulmonary hypertensive crisis and death. The systemic oxygen transport improves despite hypoxemia. Implantation is simple, feasible and safe, and the X-ray time and operation time are short. There is no severe complication or thrombosis during the mid-term follow-up of the clinical studies and the device remained patent. The syncope symptoms, six-minute walk distance, cardiac index and systemic oxygen transport improve significantly in the patients. ISD may be currently the last alternative treatment to improve symptoms and prolong survival in currently drug-resistant patients with severe PAH.

Citation： XIAO Shuna, SHANG Xiaoke, ZHANG Changdong, YUAN Yuan, ZHI Ying, HE Yan, HUANG Kai. Application of interatrial shunt device in patients with severe pulmonary hypertension. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1525-1531. doi: 10.7507/1007-4848.202108108 Copy

1.	Konstam MA, Kiernan MS, Bernstein D, et al. Evaluation and management of right-sided heart failure: A scientific statement from the American Heart Association. Circulation, 2018, 137(20): e578-e622.
2.	中華醫學會呼吸病學分會肺栓塞與肺血管病學組, 中國醫師協會呼吸醫師分會肺栓塞與肺血管病工作委員會, 全國肺栓塞與肺血管病防治協作組, 等. 中國肺動脈高壓診斷與治療指南 (2021版). 中華醫學雜志, 2021, 101(1): 11-51.
3.	Humbert M, Sitbon O, Chaouat A, et al. Pulmonary arterial hypertension in France: Results from a national registry. Am J Respir Crit Care Med, 2006, 173(9): 1023-1030.
4.	McGoon MD, Benza RL, Escribano-Subias P, et al. Pulmonary arterial hypertension: Epidemiology and registries. J Am Coll Cardiol, 2013, 62(25 Suppl): D51-D59.
5.	Galiè N, Manes A, Negro L, et al. A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Eur Heart J, 2009, 30(4): 394-403.
6.	Benza RL, Miller DP, Gomberg-Maitland M, et al. Predicting survival in pulmonary arterial hypertension: Insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation, 2010, 122(2): 164-172.
7.	Bhamra-Ariza P, Keogh AM, Muller DWM. Percutaneous interventional therapies for the treatment of patients with severe pulmonary hypertension. J Am Coll Cardiol, 2014, 63(7): 611-618.
8.	Humbert M, Sitbon O, Chaouat A, et al. Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era. Circulation, 2010, 122(2): 156-163.
9.	Humbert M, Sitbon O, Ya?ci A, et al. Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension. Eur Respir J, 2010, 36(3): 549-555.
10.	Chambers DC, Cherikh WS, Harhay MO, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: Donor and recipient size match. J Heart Lung Transplant, 2019, 38(10): 1042-1055.
11.	李賀, 王斌, 尚小珂, 等. 國產D-shant心房分流器臨床應用及超聲評估. 中華超聲影像學雜志. 2021, 30(2): 180-182.
12.	尚小珂, 張長東, 陳澍, 等. D-Shant心房分流器的初步動物實驗研究. 中國介入心臟病學雜志, 2020, 28(6): 337-342.
13.	Humbert M, Guignabert C, Bonnet S, et al. Pathology and pathobiology of pulmonary hypertension: State of the art and research perspectives. Eur Respir J, 2019, 53(1): 1801887.
14.	Huertas A, Guignabert C, Barberà JA, et al. Pulmonary vascular endothelium: The orchestra conductor in respiratory diseases: Highlights from basic research to therapy. Eur Respir J, 2018, 51(4): 1700745.
15.	Sitbon O, McLaughlin VV, Badesch DB, et al. Survival in patients with class Ⅲ idiopathic pulmonary arterial hypertension treated with first line oral bosentan compared with an historical cohort of patients started on intravenous epoprostenol. Thorax, 2005, 60(12): 1025-1030.
16.	McLaughlin VV, Sitbon O, Badesch DB, et al. Survival with first-line bosentan in patients with primary pulmonary hypertension. Eur Respir J, 2005, 25(2): 244-249.
17.	Austen WG, Morrow AG, Berry WB. Experimental studies of the surgical treatment of primary pulmonary hypertension. J Thorac Cardiovasc Surg, 1964, 48: 448-455.
18.	D'Armini AM, Callegari G, Vitulo P, et al. Risk factors for early death in patients awaiting heart-lung or lung transplantation: Experience at a single European center. Transplantation, 1998, 66(1): 123-127.
19.	Vijarnsorn C, Durongpisitkul K, Chungsomprasong P, et al. Contemporary survival of patients with pulmonary arterial hypertension and congenital systemic to pulmonary shunts. PLoS One, 2018, 13(4): e0195092.
20.	Hopkins WE, Ochoa LL, Richardson GW, et al. Comparison of the hemodynamics and survival of adults with severe primary pulmonary hypertension or Eisenmenger syndrome. J Heart Lung Transplant, 1996, 15(1 Pt 1): 100-105.
21.	Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
22.	Khan MS, Memon MM, Amin E, et al. Use of balloon atrial septostomy in patients with advanced pulmonary arterial hypertension: A systematic review and meta-analysis. Chest, 2019, 156(1): 53-63.
23.	Keogh AM, Mayer E, Benza RL, et al. Interventional and surgical modalities of treatment in pulmonary hypertension. J Am Coll Cardiol, 2009, 54(1 Suppl): S67-S77.
24.	Rothman A, Sklansky MS, Lucas VW, et al. Atrial septostomy as a bridge to lung transplantation in patients with severe pulmonary hypertension. Am J Cardiol, 1999, 84(6): 682-686.
25.	Sandoval J. Interventional therapies in pulmonary hypertension. Rev Esp Cardiol (Engl Ed), 2018, 71(7): 565-574.
26.	Rich S, Lam W. Atrial septostomy as palliative therapy for refractory primary pulmonary hypertension. Am J Cardiol, 1983, 51(9): 1560-1561.
27.	Corris PA. Alternatives to lung transplantation: Treatment of pulmonary arterial hypertension. Clin Chest Med, 2011, 32(2): 399-410.
28.	Lehner A, Schulze-Neick I, Fischer M, et al. The creation of an interatrial right-to-left shunt in patients with severe, irreversible pulmonary hypertension: Rationale, devices, outcomes. Curr Cardiol Rep, 2019, 21(5): 31.
29.	Micheletti A, Hislop AA, Lammers A, et al. Role of atrial septostomy in the treatment of children with pulmonary arterial hypertension. Heart, 2006, 92(7): 969-972.
30.	Fraisse A, Chetaille P, Amin Z, et al. Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension. Pediatr Cardiol, 2006, 27(6): 759-762.
31.	O'Loughlin AJ, Keogh A, Muller DW. Insertion of a fenestrated Amplatzer atrial septostomy device for severe pulmonary hypertension. Heart Lung Circ, 2006, 15(4): 275-277.
32.	Lammers AE, Derrick G, Haworth SG, et al. Efficacy and long-term patency of fenestrated amplatzer devices in children. Catheter Cardiovasc Interv, 2007, 70(4): 578-584.
33.	Prieto LR, Latson LA, Jennings C. Atrial septostomy using a butterfly stent in a patient with severe pulmonary arterial hypertension. Catheter Cardiovasc Interv, 2006, 68(4): 642-647.
34.	Roy AK, Gaine SP, Walsh KP. Percutaneous atrial septostomy with modified butterfly stent and intracardiac echocardiographic guidance in a patient with syncope and refractory pulmonary arterial hypertension. Heart Lung Circ, 2013, 22(8): 668-671.
35.	Aldoss O, Reinking BE, Divekar A. Native atrial septal restriction after Fontan palliation successfully treated with transcatheter Diabolo stent. Ann Pediatr Cardiol, 2016, 9(1): 49-52.
36.	Aldoss O, Divekar A. Modified technique to create diabolo stent configuration. Pediatr Cardiol, 2016, 37(4): 728-733.
37.	Sivakumar K, Rohitraj GR, Rajendran M, et al. Study of the effect of occlutech atrial flow regulator on symptoms, hemodynamics, and echocardiographic parameters in advanced pulmonary arterial hypertension. Pulm Circ, 2021, 11(1): 2045894021989966.
38.	中國醫師協會心血管內科醫師分會結構性心臟病專業委員會, 中國醫師協會心血管內科醫師分會心力衰竭專業委員會, 中國醫師協會心血管外科醫師分會結構性心臟病專業委員會, 等. 房間隔分流器治療射血分數保留心力衰竭: 中國專家認識和建議. 中國介入心臟病學雜志, 2020, 28(12): 656-661.
39.	Lammers AE, Haworth SG, Diller GP. Atrial septostomy in patients with pulmonary hypertension: Should it be recommended? Expert Rev Respir Med, 2011, 5(3): 363-376.
40.	S?ndergaard L, Reddy V, Kaye D, et al. Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure. Eur J Heart Fail, 2014, 16(7): 796-801.
41.	Amat-Santos IJ, Bergeron S, Bernier M, et al. Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure: First-in-man experience with the V-Wave device. EuroIntervention, 2015, 10(9): 1127-1131.
42.	D?browska-Kugacka A, Cie?wierz D, ?uk G, et al. Atrial flow regulator for severe drug resistant pulmonary arterial hypertension after congenital heart defect correction. Cardiol J, 2019, 26(1): 102-104.
43.	Rajeshkumar R, Pavithran S, Sivakumar K, et al. Atrial septostomy with a predefined diameter using a novel occlutech atrial flow regulator improves symptoms and cardiac index in patients with severe pulmonary arterial hypertension. Catheter Cardiovasc Interv, 2017, 90(7): 1145-1153.
44.	Patel MB, Samuel BP, Girgis RE, et al. Implantable atrial flow regulator for severe, irreversible pulmonary arterial hypertension. EuroIntervention, 2015, 11(6): 706-709.
45.	Manuri L, Calaciura RE, De Zorzi A, et al. Atrial flow regulator for failing Fontan circulation: An initial European experience. Interact Cardiovasc Thorac Surg, 2018, 27(5): 761-764.
46.	Lehner A, Schulze-Neick I, Haas NA. Creation of a defined and stable Fontan fenestration with the new Occlutech Atrial Flow Regulator (AFR?). Cardiol Young, 2018, 28(8): 1062-1066.
47.	田軍, 尚小珂, 陳澍, 等. 房間隔分流裝置臨床研究進展. 中國心血管病研究, 2021, 19(1): 86-89.
48.	尚小珂, 張長東, 陳澍, 等. 首例心房分流器置入術治療射血分數保留的心衰. 中華胸心血管外科雜志, 2021, 37(5): 3.
49.	尚小珂, 陳澍, 董念國, 等. 治療心力衰竭的新型器械—心房分流器的研究進展. 中國介入心臟病學雜志. 2020, 28(5): 274-276.
50.	尚小珂, 柳梅, 張長東, 等. 中國首例難治性心力衰竭ECMO輔助患者經皮超聲引導心房分流器植入. 中國胸心血管外科臨床雜志, 2020, 27(12): 135-136.
51.	Earley MJ. How to perform a transseptal puncture. Heart, 2009, 95(1): 85-92.
52.	Janus M, S?awek-Szmyt S, Araszkiewicz A, et al. Atrial flow regulator as a bridge to lung transplant in a young patient with drug-resistant idiopathic pulmonary arterial hypertension. Kardiol Pol, 2020, 78(5): 461-462.
53.	Vanhie E, VandeKerckhove K, Haas NA, et al. Atrial flow regulator for drug-resistant pulmonary hypertension in a young child. Catheter Cardiovasc Interv, 2021, 97(6): E830-E834.
54.	Allcock RJ, O'Sullivan JJ, Corris PA. Atrial septostomy for pulmonary arterial hypertension. Heart, 2003, 89(11): 1344-1347.
55.	McLennan D, Ivy D, Morgan GJ. Transvenous implantation of the occlutech atrial flow regulator: Preliminary results from swine models. Congenit Heart Dis, 2019, 14(5): 819-831.
56.	Kothari SS, Yusuf A, Juneja R, et al. Graded balloon atrial septostomy in severe pulmonary hypertension. Indian Heart J, 2002, 54(2): 164-169.

1. Konstam MA, Kiernan MS, Bernstein D, et al. Evaluation and management of right-sided heart failure: A scientific statement from the American Heart Association. Circulation, 2018, 137(20): e578-e622.
2. 中華醫學會呼吸病學分會肺栓塞與肺血管病學組, 中國醫師協會呼吸醫師分會肺栓塞與肺血管病工作委員會, 全國肺栓塞與肺血管病防治協作組, 等. 中國肺動脈高壓診斷與治療指南 (2021版). 中華醫學雜志, 2021, 101(1): 11-51.
3. Humbert M, Sitbon O, Chaouat A, et al. Pulmonary arterial hypertension in France: Results from a national registry. Am J Respir Crit Care Med, 2006, 173(9): 1023-1030.
4. McGoon MD, Benza RL, Escribano-Subias P, et al. Pulmonary arterial hypertension: Epidemiology and registries. J Am Coll Cardiol, 2013, 62(25 Suppl): D51-D59.
5. Galiè N, Manes A, Negro L, et al. A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Eur Heart J, 2009, 30(4): 394-403.
6. Benza RL, Miller DP, Gomberg-Maitland M, et al. Predicting survival in pulmonary arterial hypertension: Insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation, 2010, 122(2): 164-172.
7. Bhamra-Ariza P, Keogh AM, Muller DWM. Percutaneous interventional therapies for the treatment of patients with severe pulmonary hypertension. J Am Coll Cardiol, 2014, 63(7): 611-618.
8. Humbert M, Sitbon O, Chaouat A, et al. Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era. Circulation, 2010, 122(2): 156-163.
9. Humbert M, Sitbon O, Ya?ci A, et al. Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension. Eur Respir J, 2010, 36(3): 549-555.
10. Chambers DC, Cherikh WS, Harhay MO, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: Donor and recipient size match. J Heart Lung Transplant, 2019, 38(10): 1042-1055.
11. 李賀, 王斌, 尚小珂, 等. 國產D-shant心房分流器臨床應用及超聲評估. 中華超聲影像學雜志. 2021, 30(2): 180-182.
12. 尚小珂, 張長東, 陳澍, 等. D-Shant心房分流器的初步動物實驗研究. 中國介入心臟病學雜志, 2020, 28(6): 337-342.
13. Humbert M, Guignabert C, Bonnet S, et al. Pathology and pathobiology of pulmonary hypertension: State of the art and research perspectives. Eur Respir J, 2019, 53(1): 1801887.
14. Huertas A, Guignabert C, Barberà JA, et al. Pulmonary vascular endothelium: The orchestra conductor in respiratory diseases: Highlights from basic research to therapy. Eur Respir J, 2018, 51(4): 1700745.
15. Sitbon O, McLaughlin VV, Badesch DB, et al. Survival in patients with class Ⅲ idiopathic pulmonary arterial hypertension treated with first line oral bosentan compared with an historical cohort of patients started on intravenous epoprostenol. Thorax, 2005, 60(12): 1025-1030.
16. McLaughlin VV, Sitbon O, Badesch DB, et al. Survival with first-line bosentan in patients with primary pulmonary hypertension. Eur Respir J, 2005, 25(2): 244-249.
17. Austen WG, Morrow AG, Berry WB. Experimental studies of the surgical treatment of primary pulmonary hypertension. J Thorac Cardiovasc Surg, 1964, 48: 448-455.
18. D'Armini AM, Callegari G, Vitulo P, et al. Risk factors for early death in patients awaiting heart-lung or lung transplantation: Experience at a single European center. Transplantation, 1998, 66(1): 123-127.
19. Vijarnsorn C, Durongpisitkul K, Chungsomprasong P, et al. Contemporary survival of patients with pulmonary arterial hypertension and congenital systemic to pulmonary shunts. PLoS One, 2018, 13(4): e0195092.
20. Hopkins WE, Ochoa LL, Richardson GW, et al. Comparison of the hemodynamics and survival of adults with severe primary pulmonary hypertension or Eisenmenger syndrome. J Heart Lung Transplant, 1996, 15(1 Pt 1): 100-105.
21. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J, 2016, 37(1): 67-119.
22. Khan MS, Memon MM, Amin E, et al. Use of balloon atrial septostomy in patients with advanced pulmonary arterial hypertension: A systematic review and meta-analysis. Chest, 2019, 156(1): 53-63.
23. Keogh AM, Mayer E, Benza RL, et al. Interventional and surgical modalities of treatment in pulmonary hypertension. J Am Coll Cardiol, 2009, 54(1 Suppl): S67-S77.
24. Rothman A, Sklansky MS, Lucas VW, et al. Atrial septostomy as a bridge to lung transplantation in patients with severe pulmonary hypertension. Am J Cardiol, 1999, 84(6): 682-686.
25. Sandoval J. Interventional therapies in pulmonary hypertension. Rev Esp Cardiol (Engl Ed), 2018, 71(7): 565-574.
26. Rich S, Lam W. Atrial septostomy as palliative therapy for refractory primary pulmonary hypertension. Am J Cardiol, 1983, 51(9): 1560-1561.
27. Corris PA. Alternatives to lung transplantation: Treatment of pulmonary arterial hypertension. Clin Chest Med, 2011, 32(2): 399-410.
28. Lehner A, Schulze-Neick I, Fischer M, et al. The creation of an interatrial right-to-left shunt in patients with severe, irreversible pulmonary hypertension: Rationale, devices, outcomes. Curr Cardiol Rep, 2019, 21(5): 31.
29. Micheletti A, Hislop AA, Lammers A, et al. Role of atrial septostomy in the treatment of children with pulmonary arterial hypertension. Heart, 2006, 92(7): 969-972.
30. Fraisse A, Chetaille P, Amin Z, et al. Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension. Pediatr Cardiol, 2006, 27(6): 759-762.
31. O'Loughlin AJ, Keogh A, Muller DW. Insertion of a fenestrated Amplatzer atrial septostomy device for severe pulmonary hypertension. Heart Lung Circ, 2006, 15(4): 275-277.
32. Lammers AE, Derrick G, Haworth SG, et al. Efficacy and long-term patency of fenestrated amplatzer devices in children. Catheter Cardiovasc Interv, 2007, 70(4): 578-584.
33. Prieto LR, Latson LA, Jennings C. Atrial septostomy using a butterfly stent in a patient with severe pulmonary arterial hypertension. Catheter Cardiovasc Interv, 2006, 68(4): 642-647.
34. Roy AK, Gaine SP, Walsh KP. Percutaneous atrial septostomy with modified butterfly stent and intracardiac echocardiographic guidance in a patient with syncope and refractory pulmonary arterial hypertension. Heart Lung Circ, 2013, 22(8): 668-671.
35. Aldoss O, Reinking BE, Divekar A. Native atrial septal restriction after Fontan palliation successfully treated with transcatheter Diabolo stent. Ann Pediatr Cardiol, 2016, 9(1): 49-52.
36. Aldoss O, Divekar A. Modified technique to create diabolo stent configuration. Pediatr Cardiol, 2016, 37(4): 728-733.
37. Sivakumar K, Rohitraj GR, Rajendran M, et al. Study of the effect of occlutech atrial flow regulator on symptoms, hemodynamics, and echocardiographic parameters in advanced pulmonary arterial hypertension. Pulm Circ, 2021, 11(1): 2045894021989966.
38. 中國醫師協會心血管內科醫師分會結構性心臟病專業委員會, 中國醫師協會心血管內科醫師分會心力衰竭專業委員會, 中國醫師協會心血管外科醫師分會結構性心臟病專業委員會, 等. 房間隔分流器治療射血分數保留心力衰竭: 中國專家認識和建議. 中國介入心臟病學雜志, 2020, 28(12): 656-661.
39. Lammers AE, Haworth SG, Diller GP. Atrial septostomy in patients with pulmonary hypertension: Should it be recommended? Expert Rev Respir Med, 2011, 5(3): 363-376.
40. S?ndergaard L, Reddy V, Kaye D, et al. Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure. Eur J Heart Fail, 2014, 16(7): 796-801.
41. Amat-Santos IJ, Bergeron S, Bernier M, et al. Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure: First-in-man experience with the V-Wave device. EuroIntervention, 2015, 10(9): 1127-1131.
42. D?browska-Kugacka A, Cie?wierz D, ?uk G, et al. Atrial flow regulator for severe drug resistant pulmonary arterial hypertension after congenital heart defect correction. Cardiol J, 2019, 26(1): 102-104.
43. Rajeshkumar R, Pavithran S, Sivakumar K, et al. Atrial septostomy with a predefined diameter using a novel occlutech atrial flow regulator improves symptoms and cardiac index in patients with severe pulmonary arterial hypertension. Catheter Cardiovasc Interv, 2017, 90(7): 1145-1153.
44. Patel MB, Samuel BP, Girgis RE, et al. Implantable atrial flow regulator for severe, irreversible pulmonary arterial hypertension. EuroIntervention, 2015, 11(6): 706-709.
45. Manuri L, Calaciura RE, De Zorzi A, et al. Atrial flow regulator for failing Fontan circulation: An initial European experience. Interact Cardiovasc Thorac Surg, 2018, 27(5): 761-764.
46. Lehner A, Schulze-Neick I, Haas NA. Creation of a defined and stable Fontan fenestration with the new Occlutech Atrial Flow Regulator (AFR?). Cardiol Young, 2018, 28(8): 1062-1066.
47. 田軍, 尚小珂, 陳澍, 等. 房間隔分流裝置臨床研究進展. 中國心血管病研究, 2021, 19(1): 86-89.
48. 尚小珂, 張長東, 陳澍, 等. 首例心房分流器置入術治療射血分數保留的心衰. 中華胸心血管外科雜志, 2021, 37(5): 3.
49. 尚小珂, 陳澍, 董念國, 等. 治療心力衰竭的新型器械—心房分流器的研究進展. 中國介入心臟病學雜志. 2020, 28(5): 274-276.
50. 尚小珂, 柳梅, 張長東, 等. 中國首例難治性心力衰竭ECMO輔助患者經皮超聲引導心房分流器植入. 中國胸心血管外科臨床雜志, 2020, 27(12): 135-136.
51. Earley MJ. How to perform a transseptal puncture. Heart, 2009, 95(1): 85-92.
52. Janus M, S?awek-Szmyt S, Araszkiewicz A, et al. Atrial flow regulator as a bridge to lung transplant in a young patient with drug-resistant idiopathic pulmonary arterial hypertension. Kardiol Pol, 2020, 78(5): 461-462.
53. Vanhie E, VandeKerckhove K, Haas NA, et al. Atrial flow regulator for drug-resistant pulmonary hypertension in a young child. Catheter Cardiovasc Interv, 2021, 97(6): E830-E834.
54. Allcock RJ, O'Sullivan JJ, Corris PA. Atrial septostomy for pulmonary arterial hypertension. Heart, 2003, 89(11): 1344-1347.
55. McLennan D, Ivy D, Morgan GJ. Transvenous implantation of the occlutech atrial flow regulator: Preliminary results from swine models. Congenit Heart Dis, 2019, 14(5): 819-831.
56. Kothari SS, Yusuf A, Juneja R, et al. Graded balloon atrial septostomy in severe pulmonary hypertension. Indian Heart J, 2002, 54(2): 164-169.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of interatrial shunt device in patients with severe pulmonary hypertension

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