Egred M, Andron M, Albouaini K, Alahmar A, Grainger R, Morrison W L
Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, Halifax, Nova Scotia, Canada.
J Interv Cardiol. 2007 Oct;20(5):395-401. doi: 10.1111/j.1540-8183.2007.00279.x.
Percutaneous closure of atrial septal defect (ASD) and patent foramen ovale (PFO) has become increasingly utilized. The indications and results of percutaneous closure are diverse.
To assess the indications, results, and complications of percutaneous closure of ASD and PFO in our tertiary center.
Case note review and retrospective analysis of all consecutive patients undergoing percutaneous closure over a 3-year period from January 2003 to October 2005 with a mean follow-up of 19 months (4-36).
There were 185 consecutive patients. The mean age was 44.9 years (SD 12.9) and 53% (n = 98) were males. There was 59% (n = 109) PFO and 41% (n = 76) ASD. The predominant indication for PFO closure was cerebrovascular accident (CVA) (42.2%, n = 46)- and for ASD, dilated right ventricle (68.4%, n = 52). Of all procedures, 94.6% (n = 175) were first time and 5.4% (n = 10) were redo for residual shunt. Overall, the success rate was 96.8% (n = 179) with two patients referred for surgical closure due to the large size of ASD and unsuitability for percutaneous closure, two procedures abandoned due to pericardial effusion, and two abandoned because the PFO was too small to cross. The Amplatzer device was used in 92.7% (n = 166) and the Starflex in 7.3% (n = 13). Minor complications were recorded in 10 patients (5.4%), of which 4 (2.2%) had minor venous access bleeding, 1 patient (0.5%) had retroperitoneal hematoma, and 2 patients (1.1%) had transient atrial fibrillation. One patient (0.5%) had transient inferior ST elevation during the procedure, one patient (0.5%) reported chest pain postprocedure, and one patient (0.5%) developed septicemia 3 weeks postprocedure. Major complications were recorded in three patients (1.5%), one patient (0.5%) with retroperitoneal hematoma requiring blood transfusion and two patients (1%) with pericardial effusion following transseptal puncture, requiring aspiration. No death, stroke, or device embolization was recorded.
Our experience with percutaneous closure in adults demonstrates excellent results and safety with few complications. Percutaneous device closure will replace surgical closure for many ASDs and PFOs.
经皮封堵房间隔缺损（ASD）和卵圆孔未闭（PFO）的应用越来越广泛。经皮封堵的适应证和结果各不相同。
评估在我们三级中心经皮封堵ASD和PFO的适应证、结果及并发症。
回顾性分析2003年1月至2005年10月这3年间所有连续接受经皮封堵的患者的病历，平均随访19个月（4 - 36个月）。
共有185例连续患者。平均年龄为44.9岁（标准差12.9），男性占53%（n = 98）。其中PFO占59%（n = 109），ASD占41%（n = 76）。封堵PFO的主要适应证是脑血管意外（CVA）（42.2%，n = 46），封堵ASD的主要适应证是右心室扩大（68.4%，n = 52）。在所有手术中，94.6%（n = 175）是首次手术，5.4%（n = 10）是因残余分流而再次手术。总体而言，成功率为96.8%（n = 179），2例因ASD较大且不适合经皮封堵而转外科手术，2例因心包积液而放弃手术，2例因PFO过小无法穿过而放弃手术。92.7%（n = 166）使用了Amplatzer装置，7.3%（n = 13）使用了Starflex装置。10例患者（5.4%）出现轻微并发症，其中4例（2.2%）有轻微静脉穿刺部位出血，1例患者（0.5%）有腹膜后血肿，2例患者（1.1%）有短暂性房颤。1例患者（0.5%）在手术过程中出现短暂性下壁ST段抬高，1例患者（0.5%）术后报告胸痛，1例患者（0.5%）术后3周发生败血症。3例患者（1.5%）出现严重并发症，1例患者（0.5%）因腹膜后血肿需要输血，2例患者（1%）经房间隔穿刺后出现心包积液，需要穿刺抽吸。未记录到死亡、中风或装置栓塞。
我们在成人经皮封堵方面的经验显示出良好的效果和安全性，并发症较少。经皮装置封堵将取代许多ASD和PFO的外科手术封堵。
