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Nevertheless, the discovery of an extra-hepatic IGF-I production in the following years[18, 45], made it necessary to spand the conception of the GH/IGF-I axis, being well accepted nowadays that pituitary GH is able to induce IGF-I synthesis in both liver (~75%) and other tissues[23, 46, 47], which subsequently, is able to act in an endocrine/paracrine/autocrine manner

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Authors contributions PGE y RRF conceived of the study and participated in its design

transcatheter implantation of interatrial shunt or placebo control, including right heart catheterization, trans-esophageal echocardiography (TEE)/intracardiac echocardiography (ICE), and all imaging with or without guidance (for example, ultrasound, fluoroscopy), performed in an approved investigational device exemption (IDE) study) to describe the service, and we assigned the service to APC 1589 (New TechnologyLevel 38 ($10,001-$15,000)) with a payment rate of $12,500.50

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