title: [Acute left heart failure after interventional occlusion of an atrial septal defect].
abstract: Congestive left ventricular failure after surgical closure of an atrial septal defect (ASD) has been repeatedly reported, particularly in the elderly. We present a case of left ventricular failure after a successful transcatheter closure of an ASD, which to our knowledge has not been described before. In a 78-year-old woman (50 kg, 160 cm) with well-preserved left ventricular function (ejection fraction 65%) and without coronary artery disease or arterial hypertension, an ASD (Qp/Qs 1.6:1) was closed with an Amplatzer Septal Occluder without a residual shunt. Two hours after the procedure, she developed pulmonary edema due to left ventricular failure (increase of end-diastolic diameter from 42 mm to 54 mm, ejection fraction 20%), had to be mechanically ventilated for 24 hours and needed catecholamines for 4 days. High doses of diuretics were supplied until the ejection fraction normalized (32%). The patient could not be discharged until two weeks after intervention. A reduced preload for decades may predispose acute left ventricular failure, particularly in the elderly with compromised ventricular compliance.
authors.affiliation: Abteilung für Angeborene Herzfehler Deutsches Herzzentrum Berlin Augustenburger Platz 1 13353 Berlin, Germany. ewert@dhzb.de
authors.forename: P
authors.initials: P
authors.lastname: Ewert
authors.forename: F
authors.initials: F
authors.lastname: Berger
authors.forename: N
authors.initials: N
authors.lastname: Nagdyman
authors.forename: O
authors.initials: O
authors.lastname: Kretschmar
authors.forename: P E
authors.initials: PE
authors.lastname: Lange
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology*; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology; D011859:Radiography; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology*