Mathewson James W, Bichell David, Rothman Abraham, Ing Frank F
Divisions of Cardiology, Children's Hospital San Diego, in affiliation with the University of California at San Diego, San Diego, California, USA.
J Am Soc Echocardiogr. 2004 Jan;17(1):62-9. doi: 10.1016/j.echo.2003.09.018.
Using transesophageal echocardiography, we sought to determine the anatomic characteristics of the secundum atrial septal defects (ASDs) that extend into the inferior sinus venosus and have no posteroinferior (PI) rim, to determine the factors related to potential closure with an Amplatzer occluder. We also sought to understand why large secundum ASDs with a PI but without an anterosuperior (AS) rim may require special techniques to reorient the left atrial disk before deployment of the waist and right atrial disk. We measured the lengths of 5 separate rims of the circumferences of 76 secundum ASDs, including anteroinferior, AS, superior, posterosuperior, and PI rims. We also measured anteroposterior and superoinferior defect diameters, total septal lengths, and the ratios of defect diameter to total septal length. The atrial depth was measured at the axial angle of the delivery sheath in 5 defects with no AS rim for which special techniques were required to achieve successful closure. Of 76 secundum ASDs, 13 (17%) had no PI rim. Each defect extended from the fossa ovalis into the inferior sinus venosus. Compared with defects with a PI rim, the factors related to potential closure included 100% larger defect diameters, shorter posterosuperior rim lengths, larger defect to total septal length ratios, and completely flat posterior atrial walls. When the AS rim was absent the factors related to the need for special techniques included diameters >/= 22 mm, atrial depth < the calculated Amplatzer occluder left atrial disk diameter, rigid wire/disk interface, and obligatory left atrial disk orientation more or less perpendicular to the atrial septal plane.
我们采用经食管超声心动图，旨在确定延伸至下腔静脉窦且无后下（PI）缘的继发孔型房间隔缺损（ASD）的解剖特征，以确定与使用Amplatzer封堵器进行潜在封堵相关的因素。我们还试图了解为何具有PI缘但无前上（AS）缘的大型继发孔型ASD在展开腰部和右心房盘之前可能需要特殊技术来重新定位左心房盘。我们测量了76个继发孔型ASD圆周上5个不同边缘的长度，包括前下、AS、上、后上和PI边缘。我们还测量了前后和上下缺损直径、总间隔长度以及缺损直径与总间隔长度的比值。对于5个没有AS缘且需要特殊技术才能成功封堵的缺损，在输送鞘的轴向角度测量心房深度。在76个继发孔型ASD中，13个（17%）没有PI缘。每个缺损从卵圆窝延伸至下腔静脉窦。与具有PI缘的缺损相比，与潜在封堵相关的因素包括缺损直径大100%、后上缘长度短、缺损与总间隔长度比值大以及心房后壁完全平坦。当没有AS缘时，与需要特殊技术相关的因素包括直径≥22 mm、心房深度<计算出的Amplatzer封堵器左心房盘直径、刚性钢丝/盘界面以及左心房盘或多或少垂直于心房间隔平面的强制取向。
