10 May 2018
By June Shannon
Doctors in Our Lady’s Children’s Hospital in Crumlin made history in January this year when they carried out the first non-surgical Potts shunt in Ireland and the UK, for the treatment of pulmonary hypertension (PH), a rare life limiting condition.
PH is high blood pressure in the pulmonary arteries that deliver used (oxygen-depleted) blood to the lungs where the blood receives oxygen and drains back to the to the heart with the fresh (oxygen-rich) blood then being pumped out to the body. Over time the increased pressure becomes too much for the heart to deal with and it starts to fail. The symptoms of PH include breathlessness on exertion, fatigue and ankle swelling. Left untreated PH can lead to early death.
There are many causes of PH. It can develop due to a number of lung conditions, such as emphysema, or chronic bronchitis over many years or it can also develop all of a sudden for no reason. You may be born with it as a result of a genetic condition and PH can also run in families. PH is twice as common in women and it particularly affects younger women.
There is no cure for PH apart from a lung transplant and today many patients with PH are on a continuous infusion of highly expensive drugs for life which are delivered 24/7 via a pump mechanism they must wear at all times.
Left untreated Pulmonary Hypertension can lead to early death.
According to Professor Kevin Walsh, Consultant Cardiologist at the Mater Hospital and Our Lady’s Children’s Hospital in Dublin, in the past adults with IPH would have had a 50 per cent chance of surviving for three years and now thanks to new treatments such as medication this has increased to 80 per cent. However, he said that the prognosis was still poor.
Professor Walsh led the team that carried out the first non-surgical (Percutaneous) Potts Shunt procedure in Crumlin Children’s Hospital on a 16-year-old patient earlier this year.
He explained that the Potts shunt was recommended in older children and teenagers with an extremely high pressure in the lungs that has not yet resulted in heart failure.
With the Percutaneous Potts Shunt cardiologists can avoid open surgery by using a catheter to create a hole to connect the left lung artery to the aorta. This results in the high blood pressure being flowing down to the lower half of the body taking the pressure off the heart and allowing it to beat more normally.
“It means that they are less breathless, their right sided pump works better they can wean off their medications".
Prof Walsh explained, “what the Potts Shunt does is essentially to connect the left lung artery to the descending aorta….it gives a lower oxygen to the lower half of the body, but it takes the extreme pressure off the right ventricle because it drops the lung artery pressure. Creating this shunt helps them to survive longer.”
We did the first one in Ireland and England to be carried out percutaneously without surgery.
Prof Walsh said that the young patient was now doing well and starting to wean off her medication
“It means that they are less breathless, their right sided pump works better they can wean off their medications these patients would usually have a central line in place and have a pump on their back the whole time. They can wean off that and potentially get more years of a normal life,” he added.
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