Key result
Systemic-to-pulmonary shunt closure or creation in pulmonary hypertension requires careful patient selection, as operability criteria are poorly defined and procedures carry significant risks.
Why the study?
Operability criteria for closing systemic-to-pulmonary shunts are poorly defined and fail to predict survival, while creating palliative shunts for advanced pulmonary hypertension carries significant risk.
When should systemic-to-pulmonary shunts be closed or created for palliation in patients with pulmonary hypertension?
When should systemic-to-pulmonary shunts be closed or created for palliation in patients with pulmonary hypertension?
This review discusses the complex decision-making process regarding when to close existing systemic-to-pulmonary shunts and when to create palliative shunts in patients with advanced pulmonary hypertension.
Current operability criteria may not reliably guide shunt decisions in pulmonary hypertension; prospective studies needed to identify survival predictors.
Pulmonary hypertension, despite specific therapies, remains an incurable disease with a dreadful prognosis. A systemic-to-pulmonary shunt, if left unrepaired, can cause pulmonary arterial hypertension. With time, pulmonary vascular disease develops, and closure of the shunt becomes contraindicated. Operability criteria are not well defined and rely mainly on hemodynamic values that fail to predict long-term survival. Shunts can also be created in selected cases of advanced pulmonary hyper-tension, in view of off-loading the right ventricle and improving cardiac output at the cost of cyanosis. Shunt creation is not without risks and remains indicated only in selected severe cases.
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Wacker et al. (2020) conducted a review in Pulmonary hypertension. Systemic-to-pulmonary shunt closure or creation was evaluated. Systemic-to-pulmonary shunt closure or creation in pulmonary hypertension requires careful patient selection, as operability criteria are poorly defined and procedures carry significant risks.
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