Safety and utility of CardioMEMS device for remote pulmonary artery monitoring in pediatric Fontan patients: a case series.

Safety and utility of CardioMEMS device for remote pulmonary artery monitoring in pediatric Fontan patients: a case series.

Bhat DP, Graziano JN, Garn BJ, Franklin WJ.Eur Heart J Case Rep. 2023 Aug 30;7(9):ytad422. doi: 10.1093/ehjcr/ytad422. eCollection 2023 Sep. PMID: 37705945

Commentary from Dr. Thomas Zellers (Dallas, USA), section editor of Congenital Heart Disease Interventions and ACHD Journal Watch:

Take home points:

  • Fontan pressures may change with activity, elevation, and cardiac function
  • CardioMEMS is a tool that can be used for pulmonary artery pressure monitoring at home
  • CardioMEMS can be easily and safely implanted in Fontan patients using transcatheter methods

Summary: This a single center, retrospective case report of the use of the CardioMEMS device, between 09/2021 and 04/2023, in eight selective patients post Fontan procedure with Fontan associated liver disease (FALD) or protein losing enteropathy (PLE) and whose pulmonary artery pressures were in question and underwent cardiac catheterization under anesthesia. All had device placement at the time of cardia catheterization to monitor changes in PA pressures. All these patients had PA pressures that measured lower than expected given their associated organ dysfunction.

The authors present all 8 patients highlighting 2 patients who had significant increases (up to 18-20 mmHg) in their PA pressures noted by the CardioMEMS device which allowed the primary cardiologists to alter their medical therapy. The authors felt that their two cases specifically illustrate that pulmonary artery pressures can be underestimated in these patients with FALD and PLE who have catheterization under anesthesia. They emphasize that the CardioMEMS can be implanted safely and provides important follow-up hemodynamic information in this subset of Fontan patient, and potentially improves the medical management in selective situations.

Tables: Table 1