Brief Report
Implantation of an Atrial Flow Regulator in a Child on Venoarterial Extracorporeal Membrane Oxygenator as a Bridge to Heart Transplant: A Case Report

https://doi.org/10.1016/j.cardfail.2020.11.006Get rights and content

ABSTRACT

Background

Balloon dilation and stenting of the atrial septum are techniques used to unload left heart cavities in acute or end-stage heart failure in children. However, they carry significant risks such as tamponade or device embolization.

Case Presentation

We report the first case of a child with an end-stage mitochondrial cardiomyopathy on a venoarterial extracorporeal membrane oxygenator as a bridge to heart transplant where an atrial flow regulator device has been implanted.

Conclusions

This case illustrates the feasibility and safety of atrial flow regulator implantation in this setting. This procedure allowed to wean inotropic support while awaiting heart transplantation.

Section snippets

Case Report

A 12-year-old boy with a 5-year history of severe left ventricular (LV) cardiomyopathy and mitochondrial myopathy with persistent lactic acidosis, was transferred to our pediatric cardiac intensive care unit owing to angina and signs of myocardial ischemia. He had been previously followed in our outpatient clinic and progressive LV dysfunction, dilatation, and fibrosis were noted in serial cardiac magnetic resonance imaging studies (Fig. 1). A transthoracic echocardiogram on admission showed

Discussion

During VA ECMO, it is very important to create optimal cardiac unloading conditions. Different strategies and a variety of interventions such as intra-aortic balloon pump, Impella, atrial septostomy, and LV venting have been proposed. However,1,7, 8, 9, 10, 11, 12 it is unknown the exact degree of LV unloading that is necessary to achieve a balanced hemodynamic setting. Each technique carries significant associated risks, especially when used specifically in children.

The creation of an

Declaration of Competing Interest

Alain Fraisse is consultant and proctor for Abbott and for Occlutech. The other three authors have nothing to declare.

Acknowledgments

All the authors have contributed equally to the case report.

Consent

Consent has been obtained from patient and parents to use the device and publication

References (17)

  • C. Pasrija et al.

    Atrial septostomy: an alternative for left ventricular unloading during extracorporeal life support

    Ann Thorac Surg

    (2018)
  • B. Schrage et al.

    Unloading of the left ventricle during venoarterial extracorporeal membrane oxygenation therapy in cardiogenic shock

    JACC Heart Fail

    (2018)
  • Y.N. Lin et al.

    Atrial septostomy for left atrial decompression during extracorporeal membrane oxygenation by Inoue balloon catheter

    Circ J

    (2017)
  • G. Mainzer et al.

    Stenting of the inter-atrial septum in infants and small children: indications, techniques and outcomes

    Catheter Cardiovasc Interv

    (2018)
  • C. Paitazoglou et al.

    The AFR-PRELIEVE trial: a prospective, non-randomised, pilot study to assess the Atrial Flow Regulator (AFR) in heart failure patients with either preserved or reduced ejection fraction

    EuroIntervention

    (2019)
  • A. Fraisse et al.

    Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension

    Pediatr Cardiol

    (2006)
  • A. Dąbrowska-Kugacka et al.

    Atrial flow regulator for severe drug resistant pulmonary arterial hypertension after congenital heart defect correction

    Cardiol J

    (2019)
  • A. Lehner et al.

    The creation of an interatrial right-to-left shunt in patients with severe, irreversible pulmonary hypertension: rationale, devices, outcomes

    Curr Cardiol Rep

    (2019)
There are more references available in the full text version of this article.

Cited by (6)

⁎⁎

These authors have contributed equally to this work.

View full text