Carlson Karina M, Justino Henri, O'Brien Richard E, Dimas V Vivian, Leonard Glenn T, Pignatelli Ricardo H, Mullins Charles E, Smith E O'Brian, Grifka Ronald G
Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
Catheter Cardiovasc Interv. 2005 Nov;66(3):390-6. doi: 10.1002/ccd.20443.
The objective of this study was to evaluate a new technique of sizing atrial septal defects (ASDs) for transcatheter device closure. ASD closure using the Amplatzer septal occluder (ASO) device is commonly performed. Complications, including arrhythmias, pericardial effusions, and perforations, may be related to oversizing ASDs and choosing larger devices. Two methods were used to size ASDs using a compliant balloon. In some patients, the balloon was inflated until a waist was visible [(+)waist]; in others, only until no shunting was demonstrable by echocardiogram [echo; (-)waist]. The device was selected and implanted using standard procedure and echo guidance. One hundred seventeen patients underwent secundum ASD closure with an ASO device. There were 43 patients in the (-)waist group and 74 in the (+)waist group. All devices were implanted successfully. The initial echo ASD diameter was larger in the (-)waist group compared to the (+)waist group (P = 0.01). There was a smaller difference between the initial echo and balloon-sized ASD diameters in the (-)waist group (P < 0.02). ASO device size implanted (in mm greater than echo ASD diameter) was smaller in the (-)waist group (P < 0.01). There were 0/43 complications in the (-)waist group and 5/74 in the (+)waist group. The complete closure rate was the same in both groups. Sizing an ASD by inflating a compliant balloon just until shunting is eliminated, and not until a waist is visible, results in less overstretching of the ASD and selection of a smaller ASO device, achieving similar closure rates and potentially fewer complications.
本研究的目的是评估一种用于经导管封堵房间隔缺损（ASD）的新的测量技术。使用Amplatzer房间隔封堵器（ASO）进行ASD封堵是常见的操作。并发症，包括心律失常、心包积液和穿孔，可能与ASD测量过大和选择较大的封堵器有关。使用顺应性球囊采用两种方法测量ASD。在一些患者中，球囊充气直至出现腰征[（+）腰征]；在另一些患者中，仅充气至超声心动图显示无分流[超声心动图；（-）腰征]。采用标准操作并在超声心动图引导下选择并植入封堵器。117例患者接受了ASO封堵继发孔型ASD。（-）腰征组有43例患者，（+）腰征组有74例患者。所有封堵器均成功植入。（-）腰征组初始超声心动图测量的ASD直径比（+）腰征组大（P = 0.01）。（-）腰征组初始超声心动图测量的ASD直径与球囊测量的ASD直径之间的差异较小（P < 0.02）。（-）腰征组植入的ASO封堵器尺寸（比超声心动图测量的ASD直径大的毫米数）较小（P < 0.01）。（-）腰征组43例患者无并发症，（+）腰征组74例患者中有5例出现并发症。两组的完全封堵率相同。通过充气顺应性球囊直至分流消除而非直至出现腰征来测量ASD，可减少ASD的过度拉伸并选择较小的ASO封堵器，实现相似的封堵率且可能减少并发症。
