University of Nebraska/Creighton University Joint Division of Pediatric Cardiology, Children's Hospital and Medical center, Omaha, United States.
Heart Lung Circ. 2009 Dec;18(6):384-7. doi: 10.1016/j.hlc.2009.08.005. Epub 2009 Sep 26.
Although generally safe, transcatheter patent foramen ovale (PFO) closure typically involves catheter exchanges and manipulations within the left atrium (LA) that may result in complications. We describe the development of a simplified technique for PFO closure, further to modification of our earlier approaches.
Early in our experience, LA angiography and/or balloon sizing of the PFO was routine prior to device closure. Subsequently, the simplified technique described herein became our standard approach. We reviewed immediate and medium term results in 27 consecutive patients who underwent closure in a 24-month time frame.
All procedures used general anaesthesia, TEE guidance and CardioSEAL septal occluder. Device delivery was successful in all patients. The median fluoroscopy time was significantly shorter with the simplified technique (median difference 6.7min, p<0.05) with a 98.3% median confidence interval (4.5, 19.9min). There were four complications, all occurring in the early group of patients. There have been no recurrent neurological events or device related adverse events on medium term follow-up.
Successful transcatheter PFO closure is feasible without LA angiography or catheter-based balloon sizing, utilising echocardiographic guidance for device selection and placement. Simplification of PFO closure technique could potentially decrease complications and shorten fluoroscopy times.
虽然经导管卵圆孔未闭（PFO）封堵通常是安全的，但通常涉及到在左心房（LA）内进行导管交换和操作，这可能导致并发症。我们描述了一种简化的 PFO 封堵技术的发展，该技术是在我们早期方法的基础上进行了改进。
在我们的早期经验中，在进行器械封堵之前，通常需要进行 LA 血管造影和/或 PFO 球囊测量。随后，我们采用了本文描述的简化技术作为我们的标准方法。我们回顾了在 24 个月的时间框架内接受封堵的 27 例连续患者的即刻和中期结果。
所有手术均采用全身麻醉、TEE 引导和 CardioSEAL 隔瓣封堵器。所有患者的器械输送均成功。简化技术的透视时间中位数明显更短（中位数差异 6.7 分钟，p<0.05），置信区间中位数为 4.5-19.9 分钟。有 4 例并发症，均发生在早期患者组。在中期随访中，没有出现复发性神经事件或与器械相关的不良事件。
在不进行 LA 血管造影或基于导管的球囊测量的情况下，利用超声心动图指导器械选择和放置，经导管 PFO 封堵是可行的。PFO 封堵技术的简化可能会降低并发症的发生率并缩短透视时间。
