Du Zhong-Dong, Koenig Peter, Cao Q-Ling, Waight David, Heitschmidt Mary, Hijazi Ziyad M
Section of Pediatric Cardiology, Department of Pediatrics, University of Chicago Children's Hospital and Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Am J Cardiol. 2002 Oct 15;90(8):865-9. doi: 10.1016/s0002-9149(02)02709-1.
To evaluate the feasibility of transcatheter closure of secundum atrial septal defects (ASDs) associated with deficient rims (<5 mm) using the Amplatzer septal occluder (ASO), 23 patients (median age 10.7 years) underwent an attempted transcatheter closure. The patients had a deficient anterior rim of 0 to 4 mm (n = 20), an inferior rim of 2 mm (n = 2), or a posterior rim of 4 mm (n = 1) as assessed by transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE). Forty-eight patients with sufficient rims (>5 mm) who underwent closure served as controls. There were no differences between the 2 groups in ASD stretched diameter and device size (p >0.05). Of 23 patients with deficient rims, 17 (74%) had immediate complete closure compared with 44 of 48 patients (92%) with sufficient rims (p <0.05). At 24-hour and 6-month follow-up, the complete closure rates were not significantly different between the 2 groups (91% for patients with deficient rims vs 94% for patients with sufficient rims at 24 hours and 100% vs 93% at 6 months, respectively). The fluoroscopic time and procedure time were longer in patients with deficient rims (13 +/- 7 and 72 +/- 26 minutes, respectively) compared with those with sufficient rims (10 +/- 4 and 61 +/- 22 minutes, respectively). No major complications were encountered either during or after the closure procedure in both groups. Thus, transcatheter closure of ASDs associated with small anterior, inferior, or posterior rims is feasible using an ASO. Long-term follow-up data are still needed to assess long-term safety and efficacy.
为评估使用Amplatzer房间隔封堵器（ASO）经导管闭合继发孔型房间隔缺损（ASD）合并边缘不足（<5 mm）的可行性，23例患者（中位年龄10.7岁）接受了经导管闭合尝试。经食管超声心动图（TEE）或心内超声心动图（ICE）评估显示，这些患者的前边缘不足0至4 mm（n = 20），下边缘不足2 mm（n = 2），或后边缘不足4 mm（n = 1）。48例边缘充足（>5 mm）并接受闭合治疗的患者作为对照。两组在ASD伸展直径和封堵器尺寸方面无差异（p>0.05）。23例边缘不足的患者中，17例（74%）实现即刻完全闭合，而48例边缘充足的患者中有44例（92%）实现即刻完全闭合（p<0.05）。在24小时和6个月随访时，两组的完全闭合率无显著差异（边缘不足的患者分别为91%和100%，边缘充足的患者分别为94%和93%）。与边缘充足的患者相比，边缘不足的患者透视时间和手术时间更长（分别为13±7分钟和72±26分钟，而边缘充足的患者分别为10±4分钟和61±22分钟）。两组在闭合手术期间或术后均未发生重大并发症。因此，使用ASO经导管闭合合并小的前、下或后边缘的ASD是可行的。仍需要长期随访数据来评估长期安全性和有效性。
