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
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- Konagai Nao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Department of Advanced Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences
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- Fukui Shigefumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Kitano Masataka
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
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- Asaumi Yasuhide
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Nakanishi Michio
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Ogo Takeshi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Fujita Tomoyuki
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
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- Ohnishi Yoshihiko
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
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- Kobayashi Junjiro
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
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- Yasuda Satoshi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Abstract
<p>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.</p>
Journal
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- International Heart Journal
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International Heart Journal 59 (6), 1480-1484, 2018-11-30
International Heart Journal Association
