Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic
William R Miranda1, Donald J Hagler2, Guy S Reeder1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Insights
Balloon testing before atrial septal defect (ASD) closure can predict left ventricular (LV) filling pressures. Elevated baseline LV end-diastolic pressure (LVEDP) indicates higher risk for LV failure post-ASD closure.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Atrial septal defect (ASD) closure in adults with left ventricular (LV) diastolic dysfunction can precipitate LV failure.
- Temporary balloon occlusion of the ASD is a potential method to assess this risk, but data are limited.
Purpose of the Study:
- To review the experience with balloon testing prior to ASD closure in adults with LV diastolic dysfunction.
- To evaluate the utility of balloon testing in predicting hemodynamic changes and potential LV failure.
Main Methods:
- Retrospective review of 27 adult patients (age ≥50 years) undergoing temporary ASD balloon occlusion.
- Patients were assessed for suspected LV diastolic dysfunction or elevated LV end-diastolic pressure (LVEDP).
- Hemodynamic parameters including LVEDP, pulmonary artery wedge pressure (PAWP), and left atrial pressure (LAP) were measured before and during balloon occlusion.
Main Results:
- Patients with baseline LVEDP ≥15 mmHg showed significantly greater increases in LVEDP and LAP/PAWP during balloon occlusion compared to those with LVEDP <15 mmHg.
- 92% of patients with baseline LVEDP ≥15 mmHg experienced a LAP/PAWP >15 mmHg during balloon testing.
- No patients with baseline LVEDP <15 mmHg had a LAP/PAWP >15 mmHg during the test.
Conclusions:
- Baseline LVEDP may predict elevated left atrial pressure (LAP) after ASD closure.
- Comorbidities common in LV diastolic dysfunction should be considered in managing these patients.
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. 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.
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.
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