SPC365

Breaking Barriers in Heart Failure: The First Atrial Flow Regulator Implantation in Portugal

Session: MELHORES CASOS CLÍNICOS
Speaker: Francisco Barbas De Albuquerque

Congress: CPC 2025
Topic: A. Basics
Theme: 02. Clinical Skills
Subtheme: ---
Session Type: Sessão de Casos Clínicos
FP Number: ---
Authors: Francisco Barbas De Albuquerque
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Clinical Presentation</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">We present the case of a 13-year-old adolescent who had been followed at a secondary pediatric cardiology center for hypertrophic restrictive cardiomyopathy, group 2 pulmonary hypertension and subsequent advanced heart failure. She was referred to our tertiary pediatric cardiology center for further investigation and management. At the time of referral, she was in NYHA functional class III and her NT-proBNP level was 9,451 ng/mL.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Investigation and Management</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Transthoracic echocardiography (TTE) study (Figure 1A) demonstrated severe dilation of both the right atrium (62 mL/m2) and left atrium (80 mL/m2) and hypertrophy of both right ventricle (RV) and left ventricle (LV).&nbsp; Biplane LVEF was estimated in 51% and mean E/e&rsquo; ratio was 17. Echocardiographic systolic PAP was estimated in 56 mmHg, mean PAP in 36 mmHg and pulmonary acceleration time was 87 ms.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Cardiac magnetic resonance (Figure 1B, 1C) revealed significant asymmetric LV hypertrophy, with an IVS thickness of 21 mm at the meso-basal level, an LVEF of 52% and RVEF of 54%. Intramural late gadolinium enhancement in the meso-basal IVS, as well as in the mid-segments of the anterior and lateral LV walls was observed.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Right heart catheterization (RHC) was performed for further assessment: mean PAP was 36 mmHg, right PCWP was 24 mmHg and pulmonary vascular resistance (PVR) was 7 UW/m2.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Due to the elevated PVR, the patient was deemed ineligible for heart transplantation at that time. The case was discussed by the Heart Team, and it was decided to implant an Occlutech Atrial Flow Regulator (AFR) to reduce PVR and pulmonary hypertension, thereby potentially making the patient eligible for heart transplantation.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">A trans-septal puncture and interatrial septum (IAS) balloon dilation were performed, followed by successful implantation of an Occlutech AFR device (Figure 1D, 1E) in the IAS. The procedure was uneventful, with no complications during or after the intervention.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Post-procedure TTE (figure 1F) confirmed the AFR was in situ, with left-to-right shunt through the device with a maximum gradient of 11 mmHg. Echocardiographic systolic PAP was reduced to 40 mmHg. No thrombi were observed in either atrium. No pericardium effusion was detected.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">3 months after the procedure the RHC reevaluation showed a mean PAP of 36 mmHg, mean left atrium pressure of 23 and PVR of 4.7 UW/m2</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Following reassessment, the Heart Team determined that the patient had become eligible for heart transplantation and placed her on the transplant waiting list.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">This case marks the first successful Occlutech AFR implantation in Portugal, offering a novel solution for managing complex pediatric heart failure. By reducing pulmonary vascular resistance, the procedure enabled heart transplant eligibility, showcasing the potential of innovative interventions to transform care for advanced hypertrophic cardiomyopathy with pulmonary hypertension. </span></span></p>