キンジヨウ　タカヒコ   KINJIYOU Takahiko   金城　貴彦    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	Treat-and-repair strategy for atrial septal defect with left ventricular systolic dysfunction: a case report of cardiac resynchronisation therapy responder
掲載誌名	正式名：European Heart Journal - Case Reports 略　 称：Eur. Heart J. Case Rep. ISSNコード：2514-2119
掲載区分	国外
出版社	Oxford University Press
巻・号・頁	9(6),pp.x-xx
総ページ数	7
著者・共著者	Kinjo Takahiko†*, Yokoyama Hiroaki*, Sasaki Shingo, Nishizaki Kimitaka, Tomita Hirofumi
担当区分	筆頭著者,責任著者
発行年月	2025/05/22
概要	Background The treatment strategy for closing atrial septal defect (ASD) in patients with left ventricular (LV) dysfunction remains to be elucidated. Current guidelines recommend a balloon occlusion test to determine whether the ASD should be closed, fenestrated, or not. Case summary A 56-year-old man was referred to our hospital for secundum ASD with LV dysfunction. He was diagnosed with non-ischemic cardiomyopathy with LV ejection fraction of 24%. A secundum ASD with a diameter of 18 mm also existed, with a pulmonary blood flow to systemic blood flow ratio over 2.0. Initially, ASD closure was deemed challenging because the occlusion test resulted in abrupt elevation of the left atrial pressure. The patient had been implanted cardiac resynchronisation therapy (CRT) with a defibrillator for a left bundle branch block by the referring physician; however, the LV lead was positioned at the anterior interventricular vein. Since he was a non-responder for CRT, the LV lead was repositioned to the left posterior vein at our hospital. The patient’s haemodynamic status improved after CRT optimisation and medical therapy. Eventually, repeated occlusion tests allowed for successful transcatheter ASD closure. Discussion This case demonstrates a novel treat-and-repair strategy for patients with ASD and LV systolic dysfunction. Although initial evaluation precluded ASD closure, CRT optimisation and medical therapy for heart failure improved the haemodynamic status and facilitated ASD closure.
DOI	https://doi.org/10.1093/ehjcr/ytaf258