2017
DOI: 10.1002/ehf2.12234
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Pulmonary hypertension in stiff left atrial syndrome: pathogenesis and treatment in one

Abstract: We present the rare case of a patient with pulmonary hypertension in the context of the stiff left atrial syndrome after extensive catheter ablation, a unique constellation characterized by high pulmonary artery and pulmonary artery wedge pressures due to left atrial dysfunction but normal left ventricular end‐diastolic pressure, normal mitral valve, and absence pulmonary vein stenosis. This patient was surprisingly oligosymptomatic, however, which may have been due to a persistent post‐puncture atrial septal … Show more

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Cited by 7 publications
(7 citation statements)
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“…One such change, the appearance of a prominent v‐wave, has routinely been ascribed to mitral valve insufficiency. As noted above, however, the LA pressure waveform arises from the interaction between LA and mitral valve function and can display a prominent v‐wave in response to not only mitral valve insufficiency, but also, as demonstrated previously, worsening of LA compliance . Through examination of a given LA waveform, including through the identification of a sharper v‐wave upstroke, relatively prominent a‐wave, and less drastic x‐ and y‐descents, an operator might distinguish an LA waveform with prominent v‐wave reflecting reduced LA compliance from another waveform similar in morphology but arising instead from severe mitral regurgitation alone (Figure ).…”
Section: Introductionmentioning
confidence: 86%
“…One such change, the appearance of a prominent v‐wave, has routinely been ascribed to mitral valve insufficiency. As noted above, however, the LA pressure waveform arises from the interaction between LA and mitral valve function and can display a prominent v‐wave in response to not only mitral valve insufficiency, but also, as demonstrated previously, worsening of LA compliance . Through examination of a given LA waveform, including through the identification of a sharper v‐wave upstroke, relatively prominent a‐wave, and less drastic x‐ and y‐descents, an operator might distinguish an LA waveform with prominent v‐wave reflecting reduced LA compliance from another waveform similar in morphology but arising instead from severe mitral regurgitation alone (Figure ).…”
Section: Introductionmentioning
confidence: 86%
“…Since this condition is relatively new, that data is largely limited to case reports and retrospective experiences. It has been associated with postcapillary pulmonary hypertension 76–79 …”
Section: Acm Catheter Ablation and Af Ablation Surgerymentioning
confidence: 99%
“…Interestingly, a novel interventional strategy aimed at LA and LV depressurization in advanced diastolic heart failure by creating a controlled atrial septal defect [ 23 ] (“neo-ASD”) was recently applied, for the first time, to a patient with the stiff LA syndrome after 3 ablation procedures within the preceding 9 years, presenting as severe dyspnea and signs of right-sided congestion, refractory to diuretics [ 24 ]. This approach resulted in a significant clinical improvement [ 24 ], which was discussed by Maeder et al [ 25 ], who argued that a persistent post-puncture atrial septal defect was a likely explanation of only minor symptoms in their patient with the LA stiff syndrome after multiple ablations, in spite of a mean pulmonary wedge pressure of 24 mm Hg with large V-waves of 40 mm Hg.…”
Section: Stiff Left Atrial Syndrome – a Rare Complication Of Radiofrementioning
confidence: 99%