Transcatheter left atrial decompression in patients with dilated cardiomyopathy: bridging to cardiac transplantation or recovery.
Cardiol Young
; 29(3): 355-362, 2019 Mar.
Article
in En
| MEDLINE
| ID: mdl-30806346
ABSTRACT
BACKGROUND:
Left atrial congestion results from backward failure in dilated cardiomyopathy. We aimed to evaluate feasibility and efficacy of percutaneous atrioseptostomy to create a restrictive atrial septum defect in management of dilated cardiomyopathy.Methods and resultsFrom June 2009 to December 2016, 27 interventions comprised left atria decompressions in 22 dilated cardiomyopathy patients; 9 females; age 24 days to 36.9 years; weight 3-50 kg; NYHA-/Ross class IV (n=16). Mean left ventricular ejection fraction was 21.5±9.7% and brain natriuretic peptide was 2291±1992 pg/ml. Dilated cardiomyopathy was classified as chronic (n=9); acute (n=1) myocarditis; idiopathic (n=5); left ventricular non-compaction (n=4); mitochondriopathy, pacemaker induced, and arrhythmogenic (n=3). Atrioseptostomy was concomitantly performed with myocardial biopsies 6.5 days (±11.7) after admission (n=11). Trans-septal puncture was used in 18 patients; foramen ovale dilatation was done in four patients. Mean balloon size was 11 mm (range 7-14 mm); total procedure time was 133±38 minutes. No procedural complications were observed. Mean left atrial pressure decreased from 15.8±6.8 to 12.2±4.8 mmHg (p=0.005), left/right atrial pressure gradient from 9.6±5.6 to 5±3.5 mmHg; brain natriuretic peptide (n=18) decreased from 1968±1606 to 830±1083 pg/ml (p=0.01). One patient unsuitable for heart transplantation died at home despite additionally performed pulmonary artery banding and three further left atrial decompressions; five patients were bridged to transplantation, two died afterwards. Functional recovery occurred in the remaining 14 patients and in six after additional pulmonary artery banding. No patient required assist device.CONCLUSIONS:
Percutaneous left atrial decompression is an age-independent, effective palliation treating patients with dilated cardiomyopathy.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Stroke Volume
/
Cardiac Catheterization
/
Cardiomyopathy, Dilated
/
Ventricular Function, Left
/
Decompression, Surgical
/
Heart Atria
/
Cardiac Surgical Procedures
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
Limits:
Adolescent
/
Adult
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
/
Newborn
Language:
En
Journal:
Cardiol Young
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
/
PEDIATRIA
Year:
2019
Document type:
Article
Affiliation country:
Germany