Journalartikel

Jahr der Veröffentlichung: 2018

Seiten: 845-857

Zeitschrift: Clinical Research in Cardiology

Bandnummer: 107

Heftnummer: 9

ISSN: 1861-0684

eISSN: 1861-0692

DOI Link: https://doi.org/10.1007/s00392-018-1255-x

Verlag: Springer

Abstract: 

Left atrial decompression is considered in patients with symptomatic heart failure with preserved ejection fraction (HFpEF). We aimed to evaluate the feasibility and efficacy of transcatheter generation of a restrictive atrial septum communication to manage HFpEF from infancy to adulthood with cardiomyopathy and congenital heart defect.

From June 2009 to December 2016, 24 patients (50% with an age less than 16 years) with HFpEF were palliated; NYHA-/Ross class IV (n = 10); median systemic ventricular ejection fraction 64 (range 35-78) %. Cardiomyopathy was classified as a restrictive (n = 4) or hypertrophic (n = 2). (75% related to congenital heart defects) Three patients had a systemic right ventricle; in the majority of patients, HFpEF was associated to complex congenital heart defects (n = 18). Mean pulmonary arterial pressures (PAP systolic/diastolic) were 56/28 (+/- 24/13), left atrial pressures (LAP, v-, a-wave, mean) 26/25/20 (+/- 7/10/6). Trans-septal puncture was used in 22 patients; foramen ovale dilatation in 2 patients. Median balloon size was 12 (range 6-18) mm; procedure time including diagnostic measures 125 (83-221) min. No procedural death or complications were observed. Mean LA-pressures decreased significantly to 19/19/15 +/- 6/8/5 mmHg (p = 0.05); median brain natriuretic peptide (BNP) decreased from 392 (range 93-4401) pg/ml median BNP to 314 (range 61-1544) pg/ml (p = 0.05). Three patients died; one patient received orthotopic heart and one patient a heart-lung transplantation. No patient required so far an assist device. Clinical improvement occurred in all patients, in some after additional surgical or interventional approach.

Transcatheter LA decompression is an age-independent, effective palliation treating patients with HFpEF.

Harvard-Zitierstil: Bauer, A., Khalil, M., Luedemann, M., Bauer, J., Esmaeili, A., De-Rosa, R., et al. (2018) Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion, Clinical Research in Cardiology, 107(9), pp. 845-857. https://doi.org/10.1007/s00392-018-1255-x

APA-Zitierstil: Bauer, A., Khalil, M., Luedemann, M., Bauer, J., Esmaeili, A., De-Rosa, R., Voelkel, N., Akintuerk, H., & Schranz, D. (2018). Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion. Clinical Research in Cardiology. 107(9), 845-857. https://doi.org/10.1007/s00392-018-1255-x