Daehnert Ingo, Hennig Bert, Wiener Michael, Rotzsch Claudius
Klinik für Kinderkardiologie, Herzzentrum, Universität Leipzig, Leipzig, Germany.
Catheter Cardiovasc Interv. 2005 Nov;66(3):400-7. doi: 10.1002/ccd.20504.
The objective of this study was to describe the institutional experience with interventional treatment of atrial sequelae late after atrial correction for transposition of the great arteries (TGA). A retrospective observational study identified 13 long-term survivors of atrial correction for TGA (median age, 20.5 years; range, 13.8-33.0) with atrial inflow obstruction and/or interatrial defects. Balloon-expandable stents were used for relief of atrial inflow obstructions and interatrial defects closed with devices. Feasibility, periprocedural complications, residual or new obstructions or leaks at follow-up were investigated. Fourteen successful procedures were performed in 12 patients; one procedure failed. Five stents were placed for obstruction of the superior caval vein, three for obstruction of the inferior caval vein, and one for obstruction of the pulmonary venous return. Five septal occluders were implanted. Localization of the interatrial defects required atypical implantation techniques and resulted in atypical device positions. No complications occurred with stent or device implantation. There were no residual shunts through or around the septal occluders. None of the patients had new implant-related obstruction or leakage during a median follow-up of 21 months (range, 6-45). Stent implantation for obstruction of the pulmonary or systemic venous return in patients after atrial redirection for TGA is safe and effective. Follow-up suggests excellent maintenance of patency. Interatrial defects can be closed with septal occluders despite atypical defect positions in these patients. Combined use of both devices in adjacent positions is feasible. These interventions help to avoid high-risk surgery.
本研究的目的是描述大动脉转位（TGA）心房矫治术后晚期心房后遗症介入治疗的机构经验。一项回顾性观察研究确定了13例TGA心房矫治术的长期存活者（中位年龄20.5岁；范围13.8 - 33.0岁），这些患者存在心房流入道梗阻和/或房间隔缺损。使用球囊扩张支架缓解心房流入道梗阻，并用装置封闭房间隔缺损。研究了可行性、围手术期并发症、随访时的残余或新出现的梗阻或渗漏情况。12例患者共进行了14次成功的手术；1次手术失败。5个支架用于上腔静脉梗阻，3个用于下腔静脉梗阻，1个用于肺静脉回流梗阻。植入了5个房间隔封堵器。房间隔缺损的定位需要非典型植入技术，并导致封堵器位置非典型。支架或装置植入未发生并发症。房间隔封堵器周围或内部没有残余分流。在中位随访21个月（范围6 - 45个月）期间，没有患者出现新的与植入物相关的梗阻或渗漏。对于TGA心房改向后肺或体静脉回流梗阻的患者，支架植入是安全有效的。随访显示通畅性维持良好。尽管这些患者的房间隔缺损位置非典型，但仍可用房间隔封堵器封闭。在相邻位置联合使用这两种装置是可行的。这些干预措施有助于避免高风险手术。
