Pulmonary Artery Denervation for Pulmonary Artery Hypertension.

W hile the seminal advance in the treatment of pulmonary artery hypertension (PAH) over the past 2 decades has been pharmacological targeting of dysfunctional endothelium-derived pathways that contribute to the characteristic vascular remodeling of this condition irrespective of etiology (1), several novel interventional techniques have also been useful in selected patients. Atrial septostomy, which decompresses the pressureand volume-overloaded right heart and increases left heart filling and systemic perfusion, albeit at the expense of arterial oxygen desaturation (2), has been used in PAH patients with severe right heart failure refractory to diuretics and in regions where lung transplantation is not an option. More recently, balloon angioplasty has shown promise as a treatment for both inoperable Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and for patients in whom the operative risk is deemed to be unacceptably high (3). In this issue of JACC: Cardiovascular Interventions, Zhou et al. (4) provide evidence of a pivotal role of the sympathetic nervous system in the pathogenesis of PAH and demonstrate that pulmonary artery denervation (PADN) produces both hemodynamic and structural improvement in an animal model of PAH.