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A right-to-left interatrial shunt may prolong survival in patients with pulmonary hypertension presumably because of decompression of the right side of the heart. To test this hypothesis, 74 rats with monocrotaline-induced pulmonary hypertension were followed up weekly with cardiopulmonary exercise testing with a metabolic treadmill system for exercise tolerance, heart rate, oxygen uptake, carbon dioxide production, and survival until subsequent or induced death 8 weeks after monocrotaline treatment. In rats with an interatrial shunt, oxygen uptake and carbon dioxide production were higher and survival was better (n = 22, 27%) than those in rats without a shunt (n = 52, 0%; p < 0.05). For the prospective assessment of the effects of a reversed shunt, 24 other rats underwent a left superior vena cava-to-left atrial appendage anastomosis as a functional interatrial shunt (atrial septal defect group) 4 weeks after monocrotaline treatment when severe pulmonary hypertension had developed and were compared with an additional 25 rats receiving a sham operation. Both groups had exercise capacity depressed to the resting levels by 2 weeks after operation. Although transcutaneous oxygen levels decreased in response to exercise in the atrial septal defect group, uptake and carbon dioxide production stayed higher than those in the sham operation group with significantly better survival 4 weeks after operation (atrial septal defect 30% versus sham operation, 0%; p < 0.05), at which time a reversed shunt was determined with systemic embolization of intravenously infused microspheres. A right-to-left interatrial shunt, anatomic or functional, preserved basal metabolism and prolonged survival in rats with progressive pulmonary hypertension.
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