Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical experience

J Heart Lung Transplant. 2013 Apr;32(4):381-7. doi: 10.1016/j.healun.2013.01.1049. Epub 2013 Feb 14.


Background: Patients with severe pulmonary arterial hypertension (PAH) face significant morbidity and death as a consequence of progressive right heart failure. Surgical shunt placement between the left PA and descending aorta (Potts shunt) appears promising for PAH palliation in children; however, surgical mortality is likely to be unacceptably high in adults with PAH.

Methods: We describe a technique for transcatheter Potts shunt (TPS) creation by fluoroscopically guided retrograde needle perforation of the descending aorta at the site of apposition to the left PA to create a tract for deployment of a covered stent between these vessels. This covered stent-anchored by the vessel walls and surrounding tissue-serves as the shunt.

Results: TPS creation was considered in 7 patients and performed in 4. The procedure was technically successful in 3 patients; 1 patient died during the procedure as a result of uncontrolled hemothorax. One acute survivor, critically ill at the time of TPS creation, later died of comorbidities. The 2 mid-term survivors (follow-up of 10 and 4 months) are well at home, with symptomatic improvement and no late complications. The 3 candidate patients in whom the procedure was not performed died within 1 month of consideration, underscoring the tenuous nature of this population.

Conclusions: TPS creation is feasible and may offer symptomatic relief to select patients with refractory PAH. Further study of this innovative approach is warranted.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Anastomosis, Surgical / methods
  • Aorta, Thoracic / surgery*
  • Familial Primary Pulmonary Hypertension
  • Female
  • Humans
  • Hypertension, Pulmonary / surgery*
  • Male
  • Middle Aged
  • Pulmonary Artery / surgery*
  • Vascular Surgical Procedures / methods