Wang Jou-Kou, Tsai Shen-Kou, Lin Shu-Man, Chiu Shuenn-Nan, Lin Ming-Tai, Wu Mei-Hwan
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Catheter Cardiovasc Interv. 2008 Feb 1;71(2):214-21. doi: 10.1002/ccd.21308.
To evaluate the safety and feasibility of transcatheter closure of atrial septal defect (ASD) without balloon sizing.
A total of 243 patients (group I), aged 2.1-76 years (median 22 years), underwent transcatheter closure of ASD without balloon sizing. The maximal diameter of the defect was measured on transesophageal echocardiographic (TEE) images. The size of device selected was generally 4-6 mm and 5-8 mm larger than the maximal diameter, if the defect was <14 mm and > or =14 mm, respectively. The results of ASD closure in group I were compared with those of 271 patients (group II, median age 11 years) who underwent ASD closure with balloon sizing prior to the study period.
Of the 243 patients in group I, the maximal defect diameter ranged from 5.2 to 37 mm (mean 17.5 +/- 6.6 mm, median 17 mm). A total of 247 Amplatzer septal occluders were deployed in 240 patients. Two patients were found to develop distal embolization of a device the next day. Therefore, failure occurred in five patients. Comparing the results between group I and group II, there was no significant difference in success rate (238/243 vs. 263/271), incidence of embolization (2/243 vs. 2/271) and complete closure rate at 3-month follow-up (94.1% vs. 95.8%). There is significant difference in mean age (26.6 +/- 20.2 vs. 19.1 +/- 17.6), maximal defect diameter (17.5 +/- 6.6 vs. 14.1 +/- 5.9 mm) and Q(p)/Q(s) ratio (2.77 +/- 1.11 vs. 2.48 +/- 0.97) between group I and II. The mean diameter of device used was significantly larger in group I than in group II (23.1 +/- 8.1 vs. 19.6 +/- 7 mm, P < 0.001).
Balloon sizing may not be necessary in transcatheter closure of ASD.
评估不使用球囊测量大小行经导管封堵房间隔缺损（ASD）的安全性和可行性。
共有243例患者（I组），年龄2.1 - 76岁（中位年龄22岁），接受了不使用球囊测量大小的经导管ASD封堵术。在经食管超声心动图（TEE）图像上测量缺损的最大直径。如果缺损<14 mm，所选封堵器的尺寸通常比最大直径大4 - 6 mm；如果缺损≥14 mm，则大5 - 8 mm。将I组ASD封堵结果与271例患者（II组，中位年龄11岁）的结果进行比较，II组患者在研究期间之前接受了球囊测量大小的ASD封堵术。
I组的243例患者中，最大缺损直径为5.2至37 mm（平均17.5±6.6 mm，中位直径17 mm）。240例患者共植入了247个Amplatzer房间隔封堵器。发现有2例患者在术后第二天出现封堵器远端栓塞。因此，5例患者手术失败。比较I组和II组的结果，成功率（238/243 vs. 263/271）、栓塞发生率（2/243 vs. 2/271）以及3个月随访时的完全封堵率（94.1% vs. 95.8%）差异均无统计学意义。I组和II组在平均年龄（26.6±20.2 vs. 19.1±17.6）、最大缺损直径（17.5±6.6 vs. 14.1±5.9 mm）和Q(p)/Q(s)比值（2.77±1.11 vs. 2.48±0.97）方面存在显著差异。I组使用的封堵器平均直径显著大于II组（23.1±8.1 vs. 19.6±7 mm，P<0.001）。
经导管封堵ASD可能无需进行球囊测量大小。
