Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India.
Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao PAtwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India.
Indian Heart J. 2021 Mar-Apr;73(2):196-204. doi: 10.1016/j.ihj.2021.01.007. Epub 2021 Jan 6.
Potts shunt has been suggested as an effective palliative therapy for patients with pulmonary artery hypertension (PAH) not associated with congenital heart disease.
This is a prospective single-center study performed to assess outcomes of Potts shunt in patients with PAH who are in functional class III or IV.
52 patients in functional class III/IV with pulmonary arterial hypertension without significant intra or extracardiac shunt on maximal medical therapy were evaluated and counseled for undergoing Potts shunt/patent ductus arteriosus (PDA) stenting. 16/52 patients (13 females) consented for the procedure; 14 patients underwent surgical creation of Potts, and 2 underwent transcatheter stenting of PDA, which physiologically acted like a Potts shunt. Standard medical therapy was continued in patients who did not consent for the procedure. 12/16 patients survived the procedure. Patients who did not survive the procedure were older, with severe right ventricular systolic dysfunction, and functional class IV. Patients who survived the procedure were followed up in the pulmonary hypertension clinic. The Median follow-up was 17 months (1-40 months). 11/13 patients discharged after the operation showed sustained clinical, echocardiographic, and biochemical improvement, which reduced need for pulmonary vasodilator therapy in 10/13 patients. There was one death in the follow-up period 16 months post-surgery due to lower respiratory tract infection.
Potts shunt is feasible in patients with PAH without significant intra or extracardiac shunts. It can be done safely with an acceptable success rate. Patient selection, preoperative stabilization, and meticulous postoperative management are essential. It should be performed at the earliest sign of clinical, echocardiographic, or laboratory deterioation for optimal outcomes. Long-term follow-up is required to see a sustained improvement in functional class and the need for a lung transplant in the future.
对于不伴有先天性心脏病的肺动脉高压（PAH）患者，Potts 分流术已被推荐为一种有效的姑息治疗方法。
这是一项前瞻性单中心研究，旨在评估最大药物治疗后功能性 III 或 IV 级的 PAH 患者行 Potts 分流术的结果。
52 例功能性 III/IV 级、最大药物治疗后无明显心内或心外分流的肺动脉高压患者接受了评估，并接受了 Potts 分流术/动脉导管未闭（PDA）支架置入术的咨询。52 例患者中，16 例（13 例女性）同意进行该手术；14 例行 Potts 手术，2 例行 PDA 经导管支架置入术，该手术在生理上类似于 Potts 分流术。未同意手术的患者继续接受标准药物治疗。16 例患者中有 12 例存活。手术未存活的患者年龄较大，右心室收缩功能严重障碍，且为功能性 IV 级。存活的患者在肺动脉高压门诊接受随访。中位随访时间为 17 个月（1-40 个月）。手术后出院的 13 例患者中的 11 例持续临床、超声心动图和生化改善，10 例患者减少了肺动脉扩张剂治疗的需要。术后随访 16 个月时，1 例患者因下呼吸道感染死亡。
对于无明显心内或心外分流的 PAH 患者，Potts 分流术是可行的。它可以安全地进行，成功率可以接受。患者选择、术前稳定和术后精心管理至关重要。应在出现临床、超声心动图或实验室恶化的最早迹象时进行，以获得最佳结果。需要长期随访，以观察未来功能状态的持续改善和肺移植的需求。
