Matitiau A, Birk E, Kachko L, Blieden L C, Bruckheimer E
Section of Pediatric Cardiology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Isr Med Assoc J. 2001 Jan;3(1):32-5.
Secundum atrial septal defect is a common congenital heart defect that causes right heart volume overload and produces symptoms usually after the third decade of life. Treatment until the last few years has been open heart surgery.
To review our early experience with transcatheter closure of ASD2 using the Amplatzer septal occluder.
Between November 1999 and February 2000, 20 children and young adults with a median age of 9.1 years (4.2-35.1 years) were referred for transcatheter closure of ASD2. Diagnosis was established by transthoracic echocardiography. Implantation was performed under general anesthesia through the femoral vein with the guidance of transesophageal echocardiography and fluoroscopy. Femoral arterial puncture was performed for blood pressure monitoring during the procedure. The device size chosen was similar to the balloon-stretched diameter of the ASD2.
Implantation was completed successfully in 18 patients. Two patients were referred for elective surgery: one had an unsuitable anatomy for transcatheter closure by TEE in the catheterization laboratory and the device could not be implanted properly, the other patient had a large multiperforated septal aneurysm that was retrieved. Mean ASD2 diameter by TTE and TEE was similar (13.9 +/- 3 mm, 13.4 +/- 3.5 mm) and mean stretched diameter was 18.3 +/- 4.3 mm. Mean Qp:Qs (pulmonary flow:systemic flow) was 2.2 +/- 0.6. Mean fluoroscopy time for the procedure was 14.8 +/- 4.8 minutes. The patients were discharged the day after the procedure. Four patients had a tiny leak immediately post-procedure, and none had a leak at one month follow-up. The only complication was a small pseudoaneurysm of the femoral artery in one patient, that resolved spontaneously.
Transcatheter closure of ASD2 with the Amplatzer septal occluder is a safe and effective alternative to surgical closure. Long-term outcome has to be evaluated.
继发孔型房间隔缺损是一种常见的先天性心脏病，可导致右心容量负荷过重，通常在30岁以后出现症状。直到最近几年，治疗方法一直是开胸手术。
回顾我们使用Amplatzer房间隔封堵器经导管闭合继发孔型房间隔缺损（ASD2）的早期经验。
1999年11月至2000年2月，20名儿童和青年被转诊进行ASD2的经导管闭合，中位年龄为9.1岁（4.2 - 35.1岁）。通过经胸超声心动图确诊。在全身麻醉下，经股静脉，在经食管超声心动图和荧光透视引导下进行植入。术中经股动脉穿刺进行血压监测。所选封堵器尺寸与ASD2的球囊扩张直径相似。
18例患者成功完成植入。2例患者被转诊进行择期手术：1例因经食管超声心动图显示在导管室经导管闭合的解剖结构不合适，封堵器无法正确植入；另1例患者有一个大的多孔房间隔瘤，已取出封堵器。经胸超声心动图（TTE）和经食管超声心动图（TEE）测得的ASD2平均直径相似（分别为13.9±3mm和13.4±3.５mm），平均扩张直径为18.3±4.3mm。平均肺循环血流量与体循环血流量比值（Qp:Qs）为2.2±0.6。该手术平均透视时间为14.8±4.8分钟。患者术后次日出院。4例患者术后即刻有微量分流，1个月随访时均无分流。唯一的并发症是1例患者出现股动脉小假性动脉瘤，自行消退。
使用Amplatzer房间隔封堵器经导管闭合ASD2是一种安全有效的手术闭合替代方法。长期疗效有待评估。
