Uthaman Babu, Al-Qbandi Mustafa, Abushaban Lulu, Rathinasamy Jebaraj
The Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait.
Catheter Cardiovasc Interv. 2007 Sep;70(3):422-8. doi: 10.1002/ccd.21163.
We sought to evaluate the safety and efficacy of Amplatzer septal occluder (ASO) to close very large pulmonary arteriovenous fistula (PAVF).
Transcatheter coil embolization, the standard treatment for PAVF, has potential complications particularly in patients with very large fistulas. Several recently available devices have been tried effectively, however, they too have limitations.
During 2004, three patients (aged 17-56 years), diagnosed with large PAVF including one with pulmonary artery (PA) to left atrial (LA) fistula, had interventional closure prospectively using ASO. Following hemodynamic evaluation and angiographic localization of PAVF, the feeding artery (FA) was selectively cannulated with Amplatzer delivery sheath. ASO, with the right atrial (RA) disc diameter equal to or up to 4 mm larger than the maximum diameter of FA, was delivered through it in such a way that the left atrial disc assumed an oblong shape and the right atrial disc retained its designed flat configuration for better anchorage and thrombogenicity.
All patients had very large PAVF fed by a single FA (size 12-24 mm), which was closed completely, without complications, using ASO (size 7-16 mm; RA disc diameter 15-26 mm). Their arterial saturation rose from mean 72.3% to 97.3%. Follow up (1.5-3 years) showed disappearance of the radiological shadows and stable arterial saturations (mean 97.7%).
We conclude that, using the new criteria for device size selection and modified technique of implantation, very large PAVFs including PA to LA fistula can be closed safely, effectively and nonsurgically with ASO.
我们旨在评估Amplatzer房间隔封堵器（ASO）封堵非常大的肺动静脉瘘（PAVF）的安全性和有效性。
经导管弹簧圈栓塞术是PAVF的标准治疗方法，存在潜在并发症，尤其是在瘘口非常大的患者中。最近有几种可用的装置已被有效尝试，但它们也有局限性。
2004年期间，3例（年龄17 - 56岁）被诊断为大型PAVF的患者，包括1例肺动脉（PA）至左心房（LA）瘘的患者，前瞻性地采用ASO进行介入封堵。在对PAVF进行血流动力学评估和血管造影定位后，使用Amplatzer输送鞘选择性地插入供血动脉（FA）。将右心房（RA）盘直径等于或比FA最大直径大4 mm的ASO通过它输送，使左心房盘呈椭圆形，右心房盘保持其设计的扁平形态，以实现更好的锚定和血栓形成能力。
所有患者均有由单一FA供血的非常大的PAVF（大小为12 - 24 mm），使用ASO（大小为7 - 16 mm；RA盘直径为15 - 26 mm）完全封堵，无并发症。他们的动脉血氧饱和度从平均72.3%升至97.3%。随访（1.5 - 3年）显示放射学阴影消失，动脉血氧饱和度稳定（平均97.7%）。
我们得出结论，采用新的装置尺寸选择标准和改良的植入技术，包括PA至LA瘘在内的非常大的PAVF可以通过ASO安全、有效且非手术地封堵。
