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ATRIAL SEPTOSTOMY IN STIFF LEFT ATRIAL SYNDROME
1017 JACC April 5, 2016 Volume 67, Issue 13
FIT Clinical Decision Making ATRIAL SEPTOSTOMY IN STIFF LEFT ATRIAL SYNDROME Moderated Poster Contributions Pulmonary Hypertension and FIT Clinical Decision Making Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 11:00 a.m.-11:10 a.m. Session Title: FIT Clinical Decision Making: Featured Moderated Poster Session Abstract Category: Heart Failure and Cardiomyopathies Presentation Number: 1129M-09 Authors: Jae Yoon Park, Mohammed Al-Hijji, Robert Rea, Mayo Clinic, Rochester, MN, USA
Case: A 71-year-old man presented with progressive dyspnea on exertion with functional class III symptoms. History was notable for paroxysmal atrial fibrillation status post 3 ablations (most recent 8 months prior). Physical exam was notable for jugular venous pressure of 10 cmH2O with large V wave.
Decision Making: Echocardiogram was notable for mild right ventricle (RV) enlargement and systolic dysfunction, RV systolic pressure of 43 mmHg, biatrial enlargement, and mild mitral regurgitation. Cardiac CT did not reveal pulmonary vein stenosis. Catheterization demonstrated elevated left atrial (LA) pressure with a giant V wave at 39 mmHg (Figure A), mean pulmonary artery pressure of 39 mmHg, and mean right atrial pressure of 10 mmHg. A diagnosis of stiff LA syndrome was made. Given lack of response to medical therapy, he underwent balloon atrial septostomy using a 15 x 40 mm valvuloplasty balloon (Figure B). Subsequent echocardiogram demonstrated a Qp/Qs ratio of 1.6 suggestive of successful septostomy. One year out, he continues to have symptomatic improvement at functional class II symptoms. Conclusions: Stiff LA syndrome should be considered in patients with prior atrial ablations presenting with unexplained dyspnea. Invasive hemodynamic evaluation demonstrating large V waves and pulmonary hypertension in absence of mitral regurgitation is diagnostic. Atrial septostomy by alleviating left-sided pressures may represent a potential therapeutic option for patients with stiff LA syndrome not optimally controlled on medical therapy.
FIT Clinical Decision Making ATRIAL SEPTOSTOMY IN STIFF LEFT ATRIAL SYNDROME Moderated Poster Contributions Pulmonary Hypertension and FIT Clinical Decision Making Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 11:00 a.m.-11:10 a.m. Session Title: FIT Clinical Decision Making: Featured Moderated Poster Session Abstract Category: Heart Failure and Cardiomyopathies Presentation Number: 1129M-09 Authors: Jae Yoon Park, Mohammed Al-Hijji, Robert Rea, Mayo Clinic, Rochester, MN, USA
Case: A 71-year-old man presented with progressive dyspnea on exertion with functional class III symptoms. History was notable for paroxysmal atrial fibrillation status post 3 ablations (most recent 8 months prior). Physical exam was notable for jugular venous pressure of 10 cmH2O with large V wave.
Decision Making: Echocardiogram was notable for mild right ventricle (RV) enlargement and systolic dysfunction, RV systolic pressure of 43 mmHg, biatrial enlargement, and mild mitral regurgitation. Cardiac CT did not reveal pulmonary vein stenosis. Catheterization demonstrated elevated left atrial (LA) pressure with a giant V wave at 39 mmHg (Figure A), mean pulmonary artery pressure of 39 mmHg, and mean right atrial pressure of 10 mmHg. A diagnosis of stiff LA syndrome was made. Given lack of response to medical therapy, he underwent balloon atrial septostomy using a 15 x 40 mm valvuloplasty balloon (Figure B). Subsequent echocardiogram demonstrated a Qp/Qs ratio of 1.6 suggestive of successful septostomy. One year out, he continues to have symptomatic improvement at functional class II symptoms. Conclusions: Stiff LA syndrome should be considered in patients with prior atrial ablations presenting with unexplained dyspnea. Invasive hemodynamic evaluation demonstrating large V waves and pulmonary hypertension in absence of mitral regurgitation is diagnostic. Atrial septostomy by alleviating left-sided pressures may represent a potential therapeutic option for patients with stiff LA syndrome not optimally controlled on medical therapy.