{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T03:26:04Z","timestamp":1793762764022,"version":"4.6.1"},"reference-count":10,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":9,"URL":"https:\/\/www.cambridge.org\/tdm\/tdmrep-policy.json"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Pulmonary arterial hypertension in children remains a progressive disease marked by right ventricular failure and early mortality despite advances in targeted therapy. In resource-limited settings, access to parenteral prostacyclin is often constrained by cost, infrastructure, and challenges related to chronic administration. The atrial flow regulator is a transcatheter device that creates a controlled interatrial shunt to provide right-heart decompression. We describe our single-center experience with atrial flow regulator implantation in children with severe pulmonary arterial hypertension. We retrospectively reviewed six children with World Health Organization Group 1 pulmonary arterial hypertension who underwent device implantation between 2021 and 2024. Baseline assessment included echocardiography, cardiac magnetic resonance imaging, right-heart catheterization, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and 6-minute walk distance. All patients had advanced pulmonary vascular disease despite combination oral therapy. Median indexed pulmonary vascular resistance was 17.0 Wood units\u00b7m\u00b2 (10.8\u201328.5), median right ventricular ejection fraction was 31% (22\u201339), and median 6-minute walk distance was 250 m (190\u2013280). Device implantation was successful in all patients, with no periprocedural mortality. During follow-up, NT-proBNP levels decreased and 6-minute walk distance improved. Friedman testing demonstrated significant changes over time for NT-proBNP (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.002) and 6-minute walk distance (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.003). In this small cohort, atrial flow regulator implantation was technically feasible and associated with favorable longitudinal trends in biomarker and functional measures. In resource-constrained settings, it may serve as an adjunctive strategy for carefully selected high-risk patients. Larger multicenter studies are needed to refine patient selection and long-term outcomes.\n                  <\/jats:p>","DOI":"10.1017\/s1047951126123555","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T11:13:36Z","timestamp":1786360416000},"page":"1709-1712","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Transcatheter atrial flow regulator implantation in children with pulmonary arterial hypertension in resource-limited settings: a single-centre experience"],"prefix":"10.1017","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9530-8785","authenticated-orcid":false,"given":"Bibhuti","family":"Das","sequence":"first","affiliation":[{"name":"Methodist Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreesha","family":"Maiya","sequence":"additional","affiliation":[{"name":"Narayana Institute of Cardiac Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basha","family":"Khan","sequence":"additional","affiliation":[{"name":"Narayana Institute of Cardiac Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vimal","family":"Raj","sequence":"additional","affiliation":[{"name":"Narayana Institute of Cardiac Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6278-2528","authenticated-orcid":false,"given":"Shashi","family":"Raj","sequence":"additional","affiliation":[{"name":"Narayana Institute of Cardiac Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"S1047951126123555_ref1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01916-2018"},{"key":"S1047951126123555_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.05.039"},{"key":"S1047951126123555_ref3","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01345-2024"},{"key":"S1047951126123555_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2019.06.022"},{"key":"S1047951126123555_ref7","doi-asserted-by":"publisher","DOI":"10.1080\/24748706.2020.1871537"},{"key":"S1047951126123555_ref8","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2024015328"},{"key":"S1047951126123555_ref6","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2023.1073336"},{"key":"S1047951126123555_ref9","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202410-1901ST"},{"key":"S1047951126123555_ref4","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1332395"},{"key":"S1047951126123555_ref5","first-page":"304","article-title":"Atrial flow regulator and atrial septostomy in pediatric pulmonary hypertension: when procedure and device match","volume":"5","author":"Bianco","year":"2023","journal-title":"REC Interv Cardiol"}],"container-title":["Cardiology in the Young"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1047951126123555","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1047951126123555","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T02:31:50Z","timestamp":1793759510000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1047951126123555\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":10,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["S1047951126123555"],"URL":"https:\/\/doi.org\/10.1017\/s1047951126123555","relation":{},"ISSN":["1047-9511","1467-1107"],"issn-type":[{"value":"1047-9511","type":"print"},{"value":"1467-1107","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}