Chessa Massimo, Carminati Mario, Butera Gianfranco, Bini Roberta Margherita, Drago Manuela, Rosti Luca, Giamberti Alessandro, Pomè Giuseppe, Bossone Eduardo, Frigiola Alessandro
Pediatric Cardiology, Istituto Policlinico San Donato, San Donato Milanese, Italy.
J Am Coll Cardiol. 2002 Mar 20;39(6):1061-5. doi: 10.1016/s0735-1097(02)01711-4.
The goal of this study was to report the early and late complications experienced in atrial septal defect (ASD) transcatheter closure.
Atrial septal defect transcatheter occlusion techniques have become an alternative to surgical procedures. A number of different devices are available for transcatheter ASD closure. The type and rate of complications are different for different devices.
Between December 1996 and January 2001, 417 patients (mean age: 26.6 +/- 19 years) underwent transcatheter occlusion of secundum type ASD. Complications were categorized into major and minor. Two different devices were used: the CardioSEAL/STARFlex in 159 patients and the Amplatzer septal occluder in 258 patients.
Thirty-four patients experienced 36 complications during the hospitalization (8.6%, 95% confidence interval: 6.1% to 11.1%). Ten patients underwent elective surgical repair because of device malposition (three patients) or device embolization (seven patients). Twenty-four patients experienced 25 minor complications: unsatisfactory device position or embolization. Devices were retrieved using a gooseneck snare and/or a basket; 11 patients experienced arrhythmic problems. Other complications were: pericardial effusion, thrombus formation on the left atrial disc, right iliac vein dissection, groin hematoma, hemorrhage in the retropharynx and sizing balloon rupture. Two patients had late complications: peripheral embolization in the left leg one year after implantation of an Amplatzer device and sudden death 1.5 year later.
Our series of patients with ASD by transcatheter occlusion shows that the procedure is safe and effective in the vast majority of cases. To further reduce the complications rate, the criteria of device selection according to ASD morphology and some technical tips during implantation are discussed.
本研究旨在报告房间隔缺损（ASD）经导管封堵术中的早期和晚期并发症。
房间隔缺损经导管封堵技术已成为外科手术的替代方法。有多种不同的装置可用于经导管ASD封堵。不同装置的并发症类型和发生率有所不同。
1996年12月至2001年1月期间，417例患者（平均年龄：26.6±19岁）接受了继发孔型ASD的经导管封堵术。并发症分为主要并发症和次要并发症。使用了两种不同的装置：159例患者使用CardioSEAL/STARFlex，258例患者使用Amplatzer房间隔封堵器。
34例患者在住院期间出现36例并发症（8.6%，95%置信区间：6.1%至11.1%）。10例患者因装置位置不当（3例）或装置栓塞（7例）接受了择期手术修复。24例患者出现25例次要并发症：装置位置不理想或栓塞。使用鹅颈圈套器和/或网篮取出装置；11例患者出现心律失常问题。其他并发症包括：心包积液、左心房盘血栓形成、右髂静脉夹层、腹股沟血肿、咽后出血和测量球囊破裂。2例患者出现晚期并发症：植入Amplatzer装置1年后左腿外周栓塞，1.5年后猝死。
我们的经导管封堵ASD患者系列研究表明，该手术在绝大多数情况下是安全有效的。为进一步降低并发症发生率，讨论了根据ASD形态选择装置的标准以及植入过程中的一些技术要点。
