Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings
Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings
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DOI：
10.1002/ccd.28150
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发表时间：
2019-05-01
影响因子：
2.3
通讯作者：
Taggart, Nathaniel W.
中科院分区：
文献类型：
--
作者：
Miranda, William R.;Hagler, Donald J.;Taggart, Nathaniel W.
目的 回顾我们在患有左心室 (LV) 舒张功能障碍的成人房间隔缺损 (ASD) 封堵术前进行球囊测试的经验。背景 左心室舒张功能障碍患者的 ASD 封堵可能会导致左心室衰竭。在这种情况下已使用临时 ASD 闭塞，但数据有限。方法 对 2000 年至 2018 年间因疑似左室舒张功能障碍或左室舒张末压 (LVEDP) 升高而接受临时 ASD 球囊封堵术的 27 名年龄 >= 50 岁的患者进行回顾性分析。结果 中位年龄为 72 岁（IQR 66.7；75.2）。 58% 的患者患有心房颤动，58% 的患者患有高血压，26% 的患者患有冠状动脉疾病； 52%是女性。 ASD 中位尺寸为 13 mm（10；18），Qp/Qs 为 1.8（1.6；2.2）。中位 LVEDP 为 14 mmHg (12; 22)；肺动脉楔压 (PAWP) 12 mmHg (9; 16.5) 和左心房压 (LAP) 13.5 mmHg (8; 16.3)。球囊闭塞中位 5 分钟 (3; 10) 后，基线 LVEDP >= 15 mmHg 的患者 LVEDP 增加更显着（9 [6; 12] vs. 2 mmHg [0.5; 5]; p = 0.03）和 LAP/PAWP (10.5 [8.3; 16.3] vs. 1.5 mmHg [-1.5; 3]; p = 0.0003) 高于球囊测试期间基线 LVEDP 15 mmHg 的患者，而 92% 的患者基线 LVEDP >= 15 mmHg。结论 LVEDP 可用于预测 ASD 闭合后的 LAP。通常与左室舒张功能障碍相关的合并症在这些患者中很常见，在治疗时应予以考虑。
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 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.