Remadevi K S, Francis Edwin, Kumar Raman Krishna
Division of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerela, India.
Catheter Cardiovasc Interv. 2009 Jan 1;73(1):90-6. doi: 10.1002/ccd.21756.
To describe the case selection, imaging considerations, technique, and results of catheter closure of atrial septal defects (ASD) with deficient inferior vena cava (IVC) rim.
Transcatheter closure with Amplatzer septal occluder (ASO) has become standard treatment for most secundum ASDs. Defects with deficient IVC rim continue to be challenging to image and close in the catheterization laboratory.
Records of 12 patients with deficient IVC rim (<5 mm), who underwent catheter closure (April 2007 to June 2008) were reviewed. General anesthesia and transesophageal echo (TEE) guidance was used in all. The IVC rim was imaged at 70 degrees-90 degrees with retroflexion of the TEE probe, in addition to the conventional views. Devices 1-4 mm > maximal ASD size were selected. Deployment was accomplished either from the left atrium, left upper or from the right pulmonary veins.
The median age was 5.5 (2.5-27) years and median weight was 19.5 (9-65) kg. The defects measured 16-32 mm and 18-36 mm septal occluders were used. The median fluoroscopic time was 13.1 (4.2-32.7) min. Initial device selection was revised in four patients. Two patients had residual flows at IVC margin. The device embolized to right ventricular outflow tract in one patient. This was retrieved, and a larger device was deployed. No other complications were observed immediately or on follow-up (median 6; range 1-14 months).
Transcatheter closure of ASDs with deficient IVC rim is feasible under TEE guidance. The modified retroflexed view allows adequate imaging of IVC rim through TEE.
描述经导管闭合下腔静脉（IVC）边缘缺损的房间隔缺损（ASD）的病例选择、影像学考量、技术及结果。
使用Amplatzer房间隔封堵器（ASO）经导管闭合术已成为大多数继发孔型ASD的标准治疗方法。IVC边缘缺损的缺损在导管室进行成像和闭合仍具有挑战性。
回顾了12例IVC边缘缺损（<5mm）且接受经导管闭合术（2007年4月至2008年6月）患者的记录。所有患者均采用全身麻醉和经食管超声心动图（TEE）引导。除了传统视图外，通过TEE探头后屈在70度 - 90度对IVC边缘进行成像。选择比最大ASD尺寸大1 - 4mm的装置。从左心房、左上肺静脉或右肺静脉进行封堵器释放。
中位年龄为5.5（2.5 - 27）岁，中位体重为19.5（9 - 65）kg。缺损大小为16 - 32mm，使用了18 - 36mm的房间隔封堵器。中位透视时间为13.1（4.2 - 32.7）分钟。4例患者对初始装置选择进行了调整。2例患者在IVC边缘有残余分流。1例患者封堵器栓塞至右心室流出道。该封堵器被取出，并植入了更大的装置。在即刻或随访（中位时间6个月；范围1 - 14个月）时未观察到其他并发症。
在TEE引导下经导管闭合IVC边缘缺损的ASD是可行的。改良的后屈视图可通过TEE对IVC边缘进行充分成像。
