Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Temporary atrial septal defect balloon occlusion test: a must in the elderly
Session:
Sessão Speaker’s Corner - Casos clínicos desafiantes… em Cardiologia de Intervenção
Speaker:
André Filipe Macedo Alexandre
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
---
Session Type:
Sessão de Casos Clínicos
FP Number:
---
Authors:
André Alexandre; Ricardo Costa; Dias de Frias; Andreia Campinas; Anaisa Pereira; David Sá-Couto; Raquel Santos; Bruno Brochado; Filomena Oliveira; João Silveira; André Luz; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Atrial septal defect (ASD) can often remain asymptomatic until adulthood. Irrespective of symptoms, closure of a hemodynamically significant ASD with evidence of right ventricle volume overload is recommended, and transcatheter device closure has been the method of choice for secundum ASD closure in children and young adults whenever possible. However, it still remains unclear whether large ASD closure in senior people should be performed or not. Temporary ASD balloon occlusion test has been suggested as a tool to assess the risk of acute left ventricular heart failure post-ASD closure, and it allows to better distinguish responders from non-responders.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">The authors present a case of an 83-year-old man with a long-standing uncorrected secundum ASD, now admitted for recently decompensated right-sided heart failure. This patient was studied with trans-esophageal echocardiography (TEE), cardiac magnetic resonance imaging, and right heart catheterization, showing high Qp:Qs ratio and favorable anatomical conditions for percutaneous closure. Because of patient’s increasing need for intravenous diuretics and worsening renal function, it was considered that transcatheter ASD closure could improve symptoms and prevent hospitalization recurrences. Thus, we performed an attempt of percutaneous closure of the ASD with a fenestrated device. Unfortunately, during temporary balloon occlusion test, it was found a very significant increase in pulmonary capillary wedge pressure. This finding supports the existence of concealed left ventricular diastolic dysfunction, since the ASD may serve as an unloading route. Considering the risk of developing acute heart failure, we decided to abandon the procedure and not to close the ASD.</span><strong> </strong><span style="font-family:"Times New Roman",serif">The patient was oriented to optimization of medical treatment with high-dose diuretic therapy and sequential nephron blockade.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">This clinical case illustrates the value of temporary balloon test before permanent ASD occlusion in elderly patients with concealed left ventricular diastolic dysfunction. The authors suggest extending the recommendation to perform balloon testing in all patients > 60 years old, regardless of left ventricular (systolic or diastolic) dysfunction.</span></span></span></p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site