Miranda William R, Hagler Donald J, Reeder Guy S, Warnes Carole A, Connolly Heidi M, Egbe Alexander C, Taggart Nathaniel W
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
Catheter Cardiovasc Interv. 2019 May 1;93(6):1069-1075. doi: 10.1002/ccd.28150. Epub 2019 Feb 12.
To review our experience with balloon testing prior to atrial septal defect (ASD) closure in adults with left ventricular (LV) diastolic dysfunction.
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.
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).
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. None of those with a baseline LVEDP <15 mmHg had a LAP/PAWP >15 mmHg during balloon testing compared to 92% of patients with a baseline LVEDP ≥15 mmHg.
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.
回顾我们在左心室（LV）舒张功能障碍的成人患者中，进行房间隔缺损（ASD）封堵术前球囊测试的经验。
LV舒张功能障碍患者进行ASD封堵可能会引发LV衰竭。在这种情况下已使用临时ASD封堵，但数据有限。
回顾性分析2000年至2018年间，27例年龄≥50岁因疑似LV舒张功能障碍或LV舒张末期压力（LVEDP）升高而接受临时ASD球囊封堵的患者。
中位年龄为72岁（四分位间距66.7；75.2）。58%的患者有房颤，58%有高血压，26%有冠状动脉疾病；52%为女性。ASD中位大小为13mm（10；18），肺循环血流量/体循环血流量（Qp/Qs）为1.8（1.6；2.2）。LVEDP中位值为14mmHg（12；22）；肺动脉楔压（PAWP）为12mmHg（9；16.5），左心房压力（LAP）为13.5mmHg（8；16.3）。在球囊封堵中位时间5分钟（3；10）后，基线LVEDP≥15mmHg的患者LVEDP升高幅度（9[6；12]对比2mmHg[0.5；5]；p=0.03）和LAP/PAWP升高幅度（10.5[8.3；16.3]对比1.5mmHg[-1.5；3]；p=0.0003）比基线LVEDP<15mmHg的患者更大。基线LVEDP<15mmHg的患者在球囊测试期间LAP/PAWP均未>15mmHg，而基线LVEDP≥15mmHg的患者中这一比例为92%。
LVEDP可用于预测ASD封堵术后的LAP。这些患者中通常与LV舒张功能障碍相关的合并症很常见，在其管理中应予以考虑。
