A novel use of atrial septostomy and stent implantation in a patient with complex cyanotic congenital heart disease and severe pulmonary hypertension.

Patients with unpalliated complex cyanotic congenital heart may have significant morbidity resulting from severe pulmonary hypertension. In late stages, medical management is often difficult, and worsening right heart failure is resistant to medication. The risk of complications and early death can be averted by detailed evaluation and prompt intervention to identify the reversible elements that compound their physiology. It is vital to address any treatable issue to improve a patient's quality of life while awaiting heart-lung transplantation. Our case is a good example of such an approach, where the identification and treatment of reversible pulmonary venous hypertension in the background of irreversible pulmonary arterial hypertension, by offloading the left atrium by atrial septostomy and stent implantation, resulted in significant improvement in the quality of life for the patient.