March 2014, 22:6

07 March 2014

Original Paper

Original Paper

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

Jonathan Yap, Khung Keong Yeo, Ju Le Tan, Soo Teik Lim 

ASEAN Heart Journal

First online: 

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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.

Key words:

Pulmonary Hypertension - Right Ventricular - Pulmonary Arterial Hypertension - Iloprost - Primary Pulmonary Hypertension





Correspondence to Associate Professor Lim Soo Teik, Department of Cardiology, National Heart Centre Singapore, 17 Third Hospital Avenue, Singapore (168752).

Telephone: (+65) 6436 7800. Fax: (+65) 6227 3562. E-mail:

Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.


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