Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings.

Published on May 1, 2019in Catheterization and Cardiovascular Interventions2.044
· DOI :10.1002/CCD.28150
William R. Miranda14
Estimated H-index: 14
(Mayo Clinic),
Donald J. Hagler88
Estimated H-index: 88
(Mayo Clinic)
+ 4 AuthorsNathaniel W. Taggart14
Estimated H-index: 14
(Mayo Clinic)
Sources
Abstract
OBJECTIVE: To review our experience with balloon testing prior to atrial septal defect (ASD) closure in adults with left ventricular (LV) diastolic dysfunction. BACKGROUND: ASD closure in patients with LV diastolic dysfunction may precipitate LV failure. Temporary ASD occlusion has been used in this scenario but data are limited. METHODS: Retrospective review of 27 patients age ≥ 50 years undergoing temporary ASD balloon occlusion between 2000 and 2018 for suspected LV diastolic dysfunction or elevated LV end-diastolic pressure (LVEDP). RESULTS: Median age was 72 years (IQR 66.7; 75.2). Atrial fibrillation was seen in 58% of patients, hypertension in 58%, and coronary artery disease in 26%; 52% were females. Median ASD size was 13 mm (10; 18) and Qp/Qs 1.8 (1.6; 2.2). Median LVEDP was 14 mmHg (12; 22); pulmonary artery wedge pressure (PAWP) 12 mmHg (9; 16.5) and left atrial pressure (LAP) 13.5 mmHg (8; 16.3). After a median of 5 min (3; 10) of balloon occlusion, patients with baseline LVEDP ≥15 mmHg had more significant increases in LVEDP (9 [6; 12] vs. 2 mmHg [0.5; 5]; p = 0.03) and LAP/PAWP (10.5 [8.3; 16.3] vs. 1.5 mmHg [-1.5; 3]; p = 0.0003) than those with baseline LVEDP 15 mmHg during balloon testing compared to 92% of patients with a baseline LVEDP ≥15 mmHg. CONCLUSION: LVEDP might be used to predict LAP post-ASD closure. Comorbidities typically associated with LV diastolic dysfunction are common in these patients and should be considered in their management.
📖 Papers frequently viewed together
3 Citations
22 Citations
1 Citations
References25
Newest
#1Mark K. Friedberg (U of T: University of Toronto)H-Index: 42
Abstract The impact of one ventricle on the adjacent ventricle plays a key role in cardiac function. Ventricular-ventricular interactions are based on the arrangement in-series of the circulation and common pericardium, interventricular septum, and myocardial tracts. Imaging, in particular echocardiography, plays a central role in characterizing these interactions through geometric indices, septal configuration and motion, Doppler flow, timing of events in the ventricles and alterations in strai...
28 CitationsSource
#1Julia Mascherbauer (Medical University of Vienna)H-Index: 26
#2Caroline Zotter-Tufaro (Medical University of Vienna)H-Index: 13
Last. Diana Bonderman (Medical University of Vienna)H-Index: 33
view all 8 authors...
Abstract Objectives This study sought to compare the prognostic power of left ventricular end-diastolic pressure (LVEDP) and pulmonary arterial wedge pressure (PAWP) in heart failure with preserved ejection fraction (HFpEF). Background It is broadly accepted that direct measurement of LVEDP in HFpEF more robustly reflects left ventricular hemodynamics than PAWP. Methods A total of 173 consecutive HFpEF patients were prospectively enrolled. Of these, 152 patients fulfilled registry inclusion crit...
33 CitationsSource
#1William R. Miranda (Mayo Clinic)H-Index: 14
#2Jae K. Oh (Mayo Clinic)H-Index: 119
Abstract Constrictive pericarditis (CP) represents a form of severe diastolic heart failure (HF), secondary to a noncompliant pericardium. The true prevalence of CP is unknown but it is observed in 0.2–0.4% of patients who have undergone cardiac surgery or have had pericardial trauma or inflammation due to a variety of etiologies. Despite its poor prognosis if untreated, CP is a potentially curable disease and surgical pericardiectomy can now be performed at low perioperative mortality in tertia...
22 CitationsSource
#1Young Hwa Kong (SMC: Samsung Medical Center)H-Index: 1
#2Jinyoung Song (SMC: Samsung Medical Center)H-Index: 10
Last. I-Seok Kang (SMC: Samsung Medical Center)H-Index: 14
view all 5 authors...
Background: Acute changes in left ventricular diastolic function shortly after ASD closure in elderly patients have not been well known. We aimed to investigate acute changes in left ventricular end diastolic pressure (LVEDP) in elderly patients following transcatheter closure of atrial septal defect (ASD). Methods: All 19 adults with ASDs who underwent transcatheter closure between June 2013 and December 2014 were enrolled. LVEDP was measured prior to device closure and compared with that immed...
2 CitationsSource
#1Monika Komar (Jagiellonian University)H-Index: 8
#2Tadeusz Przewłocki (Jagiellonian University)H-Index: 21
Last. Piotr Podolec (Jagiellonian University)H-Index: 23
view all 5 authors...
Objective Closure of an atrial septal defect in elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defects (ASDs) in elderly patients.
20 CitationsSource
#1Terrence D. Welch (Dartmouth–Hitchcock Medical Center)H-Index: 5
#2Lieng H. LingH-Index: 29
Last. Jae K. Oh (Mayo Clinic)H-Index: 119
view all 8 authors...
Background —Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed. Methods and Results —Patients with surgically-confirmed constrictive pericarditis (n=130) at Mayo Clinic (2008-2010) were compared to patients (n=36) diagnosed w...
118 CitationsSource
#1Satoshi Masutani (Saitama Medical University)H-Index: 18
#2Hideaki Senzaki (Saitama Medical University)H-Index: 26
Abstract Despite advances in device closure for atrial septal defect (ASD), post-closure heart failure observed in adult patients remains a clinical problem. Although right heart volume overload is the fundamental pathophysiology in ASD, the post-closure heart failure characterized by acute pulmonary congestion is likely because of age-related left ventricular diastolic dysfunction, which is manifested by acute volume loading with ASD closure. Aging also appears to play important roles in the pa...
39 CitationsSource
#1L. Swan (UHN: University Health Network)H-Index: 1
#2C. Varma (UHN: University Health Network)H-Index: 1
Last. Peter R. McLaughlin (UHN: University Health Network)H-Index: 57
view all 7 authors...
Abstract Background Device closure of an atrial septal defect (ASD) results in symptom-reduction, right heart remodelling and lower pulmonary artery pressures. However it is unclear if there is a chronological limit to these benefits and whether device closure is safe in elderly subjects. The aim of this study was, therefore, to assess the safety and efficacy of device closure in patients >60 years. Methods Retrospective study of Amplatzer Septal Occluder™ device closures from a single instituti...
60 CitationsSource
Transcatheter closure of atrial septal defects (ASDs) is a safe and effective treatment. Over the past years, an increasing number of elderly patients (age > 60 years) have been admitted for transcatheter closure to prevent ongoing congestive heart failure from volume overload. However, recent data point to the risk of serious acute left ventricular dysfunction leading to pulmonary edema immediately after surgical or transcatheter ASD closure in some patients. In this study, we used a technique ...
109 CitationsSource
Abstract Objectives We prospectively examined whether surgical treatment of secundum atrial septal defects (ASDs) in patients ≥40 years old improves their long-term clinical outcome. Background Surgical treatment of secundum ASDs in adults >40 years old is a subject of controversy because of the perception of good long-term clinical outcomes in patients with unrepaired ASDs and the lack of data from randomized trials. Methods We recruited 521 patients >40 years old with secundum ASDs referred fo...
319 CitationsSource
Cited By4
Newest
#1Jimmy Windsor (Roy J. and Lucille A. Carver College of Medicine)H-Index: 10
#2Chaitra Mukundan (Roy J. and Lucille A. Carver College of Medicine)
Last. Harish Ramakrishna (Mayo Clinic)H-Index: 20
view all 4 authors...
Abstract Adult congenital heart disease (ACHD) continues to rapidly increase worldwide. With an estimated 1.5 million adults with ACHD alone in the USA, there is a growing need for better education in the management of these complex patients and multiple knowledge gaps exist. This manuscript will comprehensively review the recent (2020) updated ESC Guidelines for the management of adult congenital heart disease created by the Task Force for the management of adult congenital heart disease of the...
Source
#1Shuhei Tanaka (University of Toyama)H-Index: 2
#2Teruhiko Imamura (University of Toyama)H-Index: 11
Last. Koichiro Kinugawa (University of Toyama)H-Index: 15
view all 6 authors...
Atrial septal defects (ASDs) are one of the most common congenital heart disorders encountered by cardiologists. Percutaneous ASD closure for secundum ASD is commonly performed not only for children but also for adults, given its non-inferiority to surgical repair. The choice of closure technique should be based on assessing a patient's baseline comorbidities, including the presence of pulmonary hypertension, supraventricular tachycardias, and left ventricular diastolic dysfunction. Furthermore,...
Source
#1Lucy Youngmin Eun (Yonsei University)H-Index: 7
#2Han Ki Park (Yonsei University)H-Index: 13
Last. Jae Young Choi (Yonsei University)H-Index: 16
view all 3 authors...
Transcatheter device closure of a secundum atrial septal defect (ASD) is followed by a noticeable change in the left atrium (LA) and left ventricle (LV) over a long-term follow-up. This study aimed to assess the remodeling of the atrial and ventricular myocardium with respect to diastolic function in adult ASD patients. Around 38 asymptomatic patients (age: 48.6 ± 17.1 years, range: 23–69 years) diagnosed with ASD during routine health check-up and who underwent ASD device closure with the Ampla...
Source
#1Mario Giordano (Seconda Università degli Studi di Napoli)H-Index: 37
#2Gianpiero Gaio (Seconda Università degli Studi di Napoli)H-Index: 11
Last. Maria Giovanna Russo (Seconda Università degli Studi di Napoli)H-Index: 47
view all 10 authors...
Abstract Background Elderly patients (≥60 years) with an atrial septal defect (ASD) are a complex subgroup with several haemodynamic limitations. The aim of this study is to describe the clinical and haemodynamic features of these patients and the effectiveness of percutaneous ASD closure in this setting. Methods This is an observational retrospective study. From 2000 to 2018, sixty-eight elderly patients (65.1 ± 3.8 years, range 60–75) underwent ASD assessment at our institution. Right heart ca...
1 CitationsSource