Successful transcatheter atrial septal defect closure prior to coronary artery bypass grafting using anti-congestive therapies and intraaortic balloon pumping in a patient with severe ischemic cardiomyopathy and triple-vessel coronary artery disease

Nao Konagai, Shigefumi Fukui, Masataka Kitano, Yasuhide Asaumi, Michio Nakanishi, Takeshi Ogo, Tomoyuki Fujita, Yoshihiko Ohnishi, Junjiro Kobayashi, Satoshi Yasuda

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

In patients with an atrial septal defect (ASD) and left ventricular (LV) dysfunction associated with coronary artery disease (CAD), to avoid the development of acute left heart failure (HF) and an increase in myocardial oxygen consumption following ASD closure, it is conceivable that coronary artery revascularization should be performed prior to ASD closure. We report the case of a 67-year-old man with a large secundum ASD and LV ejection fraction of 15.6% resulting from severe ischemic cardiomyopathy and triple-vessel CAD, both of which contributed to biventricular HF characterized by high left-to-right shunt (Qp:Qs of 7.1:1) and low systemic cardiac output. After evaluating his hemodynamics and biventricular function with cardiac catheterization and cardiovascular magnetic resonance imaging, we successfully conducted an inverse, stepwise strategy of transcatheter ASD closure using anti-congestive therapies, intraaortic balloon pumping, and subsequent balloon occlusion testing, followed by on-pump beating-heart coronary artery bypass grafting.

Original languageEnglish
Pages (from-to)1480-1484
Number of pages5
JournalInternational heart journal
Volume59
Issue number6
DOIs
Publication statusPublished - 2018 Jan 1
Externally publishedYes

Keywords

  • Anti-heart failure therapy
  • Coronary artery revascularization
  • Device closure
  • Interatrial communication
  • Left ventricular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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