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The Potts shunt has been proposed as a strategy to alleviate symptoms and to delay lung transplantation in paediatric patients with pulmonary arterial hypertension (PAH) [1]. In a similar way to patients with Eisenmenger physiology with a patent ductus arteriosus, the Potts shunt may confer protection to the pressure-overloaded right ventricle in patients with suprasystemic pulmonary pressures. The results, in selected paediatric patients, have been encouraging in terms of survival, World Health Organization (WHO) functional classification and need for transplantation [1–4]. Recently, modifications to the classic Potts shunt have been reported by creating a unidirectional central valved conduit to protect the pulmonary circulation from reverse shunting [5, 6]. We report a second adult patient who underwent placement of a central unidirectional (valved) Potts shunt for severe suprasystemic PAH. After 1 year of follow up, the patient demonstrated overall clinical improvement with a significant increase in exercise tolerance., For young adults with end-stage idiopathic pulmonary hypertension, a valved graft connecting the central pulmonary artery to the distal aortic arch can provide substantial palliation of symptoms and may defer lung transplantation https://bit.ly/2TvMFFC

The Initial Systolic Time Interval (ISTI), obtained from the electrocardiogram (ECG) and impedance cardiogram (ICG), is considered to be a measure for the time delay between the electrical and mechanical activity of the heart and reflects an early active period of the cardiac cycle. The clinical relevance of this time interval is subject of study. This paper introduces a method using ISTI to evaluate and predict the circulatory response to fluid administration in patients after coronary artery bypass graft surgery and presents preliminary results of a pilot study by comparing ISTI with cardiac output (CO) responsiveness. Also the use of the pulse transit time (PTT), earlier recommended for this purpose, was investigated. The results showed an inverse relationship between ISTI and CO at all moments of fluid administration and also an inverse relationship between the changes ΔISTI and ΔCO before and after full fluid administration. No relationships between PTT and CO or ΔPTT and ΔCO were found. It is concluded that ISTI is dependent upon preload, and that ISTI has the potential to be used as a clinical parameter assessing preload.