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Clinical Research in Cardiology

, Volume 107, Issue 9, pp 845–857 | Cite as

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

  • Anna Bauer
  • Markus Khalil
  • Monika Lüdemann
  • Jürgen Bauer
  • Anoosh Esmaeili
  • Roberta De-Rosa
  • Norbert F. Voelkel
  • Hakan Akintuerk
  • Dietmar Schranz
Original Paper

Abstract

Background

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.

Methods and results

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.

Conclusions

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

Keywords

Diastolic heart failure Preserved ejection fraction Atrial septostomy, restrictive atrial communication 

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Anna Bauer
    • 1
  • Markus Khalil
    • 1
  • Monika Lüdemann
    • 1
  • Jürgen Bauer
    • 1
  • Anoosh Esmaeili
    • 2
  • Roberta De-Rosa
    • 3
  • Norbert F. Voelkel
    • 4
  • Hakan Akintuerk
    • 1
  • Dietmar Schranz
    • 1
    • 2
  1. 1.Hessen Pediatric Heart CenterJustus Liebig University Clinic GiessenGiessenGermany
  2. 2.Hessen Pediatric Heart CenterJohann-Wolfgang Goethe University Hospital FrankfurtFrankfurtGermany
  3. 3.Cardiovascular DepartmentUniversity of SalernoFiscianoItaly
  4. 4.Free University Medical Center (VUMC) AmsterdamAmsterdamThe Netherlands

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