{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T19:48:26Z","timestamp":1760298506142},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2012,11,14]],"date-time":"2012-11-14T00:00:00Z","timestamp":1352851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2013,4]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study aimed at identifying the ideal right\u2010to\u2010left shunt\u2010fraction to improve cardiac output (CO) and systemic perfusion in pulmonary arterial hypertension (PHT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Atrial septostomy (AS) has been a high\u2010risk therapeutic option for symptomatic drug\u2010refractory patients with PHT. Results have been unpredictable due to limited knowledge of the optimal shunt\u2010quantity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In nine dogs, an 8\u2010mm shunt\u2010prosthesis was inserted between the superior vena cava (SVC) and the left atrium. With pulmonary artery (PA) banding, mean (\u00b1SEM) systolic right ventricular pressure increased from 37 \u00b1 1 mm Hg at baseline to 44 \u00b1 1 mm Hg (moderate PHT, <jats:italic>P<\/jats:italic> = 0.005) and 50 \u00b1 2 mm Hg (severe PHT, <jats:italic>P<\/jats:italic> &lt; 0.001). Shunt\u2010flow was adjusted by total (forcing all flow through the shunt) or partial occlusion of the SVC and partial or total clamping of the shunt. Caval\u2010, shunt\u2010, and aortic\u2010flow were measured by ultrasonic flow\u2010probes. Blood gases were drawn from the aortic root and PA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At severe PHT, a shunt\u2010flow of 11 \u00b1 1% of CO (253 \u00b1 90 mL\/min) increased CO significantly by 25% (1.8 \u00b1 0.1 to 2.4 \u00b1 0.2 L\/min, <jats:italic>P<\/jats:italic> = 0.005) causing an increase of systemic oxygen delivery index (DO<jats:sub>2<\/jats:sub>I) by 23% (309 \u00b1 23 to 399 \u00b1 32 mL\/min\/m<jats:sup>2<\/jats:sup>, <jats:italic>P<\/jats:italic> = 0.035). Arterial O<jats:sub>2<\/jats:sub>\u2010saturation did not change significantly until a shunt\u2010flow of 18 \u00b1 2% was exceeded, causing a drop from 96 \u00b1 1% to 84 \u00b1 4% (<jats:italic>P<\/jats:italic> = 0.013). At moderate PHT, CO or DO<jats:sub>2<\/jats:sub>I did not improve significantly at any shunt\u2010flow.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In severe PHT, a shunt\u2010flow of 11% of CO represented the ideal shunt\u2010fraction. Augmentation of CO compensated for declined O<jats:sub>2<\/jats:sub>\u2010saturation due to right\u2010to\u2010left shunting and improved DO<jats:sub>2<\/jats:sub>I. In moderate PHT, AS is less promising. \u00a9 2012 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.24458","type":"journal-article","created":{"date-parts":[[2012,4,18]],"date-time":"2012-04-18T10:23:25Z","timestamp":1334744605000},"page":"888-895","source":"Crossref","is-referenced-by-count":10,"title":["Impact of differential right\u2010to\u2010left shunting on systemic perfusion in pulmonary arterial hypertension"],"prefix":"10.1002","volume":"81","author":[{"given":"Timo","family":"Weimar","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery Washington University School of Medicine Barnes\u2010Jewish Hospital St. Louis Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiyuki","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Washington University School of Medicine Barnes\u2010Jewish Hospital St. Louis 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