1Evangelisches Krankenhaus Paul Gerhardt Stift Medizinische Klinik III - Kardiologie und Angiologie Lutherstadt - Wittenberg, Deutschland; 2Evangelisches Krankenhaus Paul Gerhardt Stift Medizinische Klinik II - Kardiologie und Angiologie Lutherstadt - Wittenberg, Deutschland
Background
Heart failure with preserved ejection fraction (HFpEF) remains a major therapeutic challenge. Creation of an interatrial communication to offload the left atrium is a possible therapeutic approach which can be achieved through balloon septostomy and interatrial shunt implantation. Here we present a case report of atrial shunt implantation in a patient with spontaneous closure of atrial shunt more than two years after initial balloon septostomy without device implantation.
Case report
A 77 year old female patient with HFpEF presented in our emergency department with new onset dyspnoe symptoms (NYHA III) more than two years after undergoing a balloon septostomy at our center for reducing the left atrial pressure through formation of left to right shunt which had initially lead to a significant improvement in her symptoms and quality of life. A TEE performed at current presentation demonstrated that the shunt was no longer present. A right heart catheterisation was carried out in which significant increase in wedge pressure was seen under exercise (>10mmHg). Latent pulmonary vascular disease (PVR: 1.8 WU) and relevant pulmonary hypertension were ruled out. Following this, the decision to perform an atrial shunt device implantation was made. Under TEE and fluoroscopic guidance, an Occlutech atrial flow regulator with 8mm fenestration was implanted. A left to right shunt was documented following the intervention. The patient could be discharged the following day. A follow-up performed at three months showed significant improvement in symptoms (NYHA III->NYHA II). In the transthoracic echocardiography, the device was patent with left to right shunt without worsening of right heart function.
Conclusion
Creation of an interatrial communication is an effective treatment option to decompress the left heart in patients with HFpEF leading to clear improvement in symptoms and quality of life.