A Bridge Therapy for Patients with Heart Failure and Hypertensive Left Atrial Pressures by Using Transcatheter Creation of a Restrictive Atrial Communication

Background: Left atrial decompression can be beneficial in patients with symptomatic heart failure with hypertensive left atrium. We analyzed our patients treated with transcatheter creation of a restrictive atrial septum communication related to clinical improvement and outcomes for future treatment as well as heart transplantation.

Method: From February 2018 to September 2022, all patients with high left atrial hypertension, who underwent transcatheter creation of restrictive atrial septum communication, were included in the study.

Results: A total of 16 patients (female, n = 9; 13/16 [81.2%] with an age ≤ 13 years; median weight 12 kg [range: 2.8–80]) with heart failure and high left atrial pressure were intervened. The median systemic ventricular ejection fraction 53.5% (range: 25–76). The diagnoses of patients were as following: restrictive cardiomyopathy (n = 2), dilated cardiomyopathy (n = 2), hypertrophic cardiomyopathy (n = 1), noncompaction cardiomyopathy (n = 1), mitral valve stenosis (n = 2), aortic stenosis (n = 2), hypoplastic left heart syndrome (n = 4), double inlet right ventricle (n = 1), and left ventricular failure after myocardial infarction due to Kawasaki disease (n = 1). The median left and right atrial pressure (mean) were 16 mm Hg (range: 9–26) and 6 mm Hg (range: 3–19), respectively. Transseptal puncture was performed in 15/16 patients. The median balloon size, procedure time, and fluoroscopy time were 11 mm (range: 5–18), 111 minutes (range: 53–189) and 17.2 min (range: 8.6–30.1), respectively. After balloon dilatation, the median left atrial pressure (mean) decreased significantly to 12.5 mm Hg (range: 7–24) (p = 0.002) and the mean right atrial pressure increased to 7 mm Hg (range: 3–17) (p < 0.01). All patients have improved clinically. The median follow-up was 32.1 months (range: 1–55). One patient diagnosed with myocardial infarction after Kawasaki disease received orthotopic heart transplantation. No cardiac assist device was necessary in the other patients. No procedural death or complications occurred.

Conclusion: Percutaneous transcatheter left atrial decompression seems as a reliable and efficient treatment method in children with symptomatic heart failure due to left atrial hypertension.