Pulmonary arterial hypertension is a syndrome resulting from restricted flow through the pulmonary arterial circulation resulting in increased pulmonary vascular resistance and ultimately leading to right heart failure.
It is a part of the spectrum of pulmonary hypertension, which is hemodynamic and pathophysiological condition defined as an increase in mean pulmonary arterial pressure ≥25 mmHg at rest.
Typical symptoms include progressive dyspnea on exertion, palpitations, fatigue, weakness, angina, syncope and abdominal distention.

Surgical Intervention

Balloon Atrial Septostomy (BAS)

  • Several experimental & clinical observations suggest that an atrial defect may be of benefit in the setting of pulmonary hypertension (PH) as it would allow right to left shunting which increases systemic output
    • This would increase systemic arterial oxygen saturation
    • It also decompresses the right atrium & ventricle therefore decreasing signs & symptoms of right heart failure
  • At present, indications for BAS are:
    • Patients who are in World Health Organization functional class (WHO FC) IV with severe syncope &/or right heart failure despite all available medical treatments
    • Palliative bridge to lung transplantation
    • Sole treatment modality when other options are not available
    • Considered in pulmonary arterial hypertension (PAH) associated with surgically corrected congenital hear disease (CHD), connective tissue disease, distal chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary veno-occlusive disease & pulmonary capillary hemangiomatosis
    • May be considered before severe hemodynamic compromise & end-organ dysfunction occur
  • Should be performed only at institutions with significant procedural & clinical experience
  • Avoided in patients with a baseline mean right atrial pressure (RAP) of 20 mmHg & O2 saturation at rest of <85% on room air


  • There is no agreement on the optimal type of transplantation for patients with PAH, whether single lung, double lung or combined heart & lung
  • Indicated in PAH patients when they have an unacceptable response to PAH therapies seen in FC III or IV
  • Due to lack of effective medical therapeutic regimen, patients with pulmonary veno-occlusive disease & pulmonary capillary hemangiomatosis should be candidates for transplantation at diagnosis
  • Survival rates in PAH patients undergoing transplant: 66% at 1 year, 57% at 3 years, 47% at 5 years & 27% at 10 years
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
02 Aug 2018
At a dinner symposium at Le Méridien Kuala Lumpur, Professor Dato’ Prepageran Narayanan presented the data concerning allergic rhinitis (AR) in Malaysia, and he discussed the role of intranasal corticosteroids (INCSs) in managing AR.
12 Nov 2017
Active and passive smoking are associated with atopic dermatitis, a new study from Korea reveals.
Pearl Toh, 19 Apr 2017
Almost half of secondary school children who had been diagnosed with asthma had suboptimal asthma control, yet over half of those surveyed did not use their inhalers as prescribed, a recent study found.