Rigatelli Gianluca, Dell'Avvocata Fabio, Ronco Federico, Giordan Massimo, Cardaioli Paolo
Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Via WA Mozart 9, Legnago, Verona, Italy.
Cardiol Young. 2010 Apr;20(2):144-9. doi: 10.1017/S1047951109990631. Epub 2010 Mar 11.
Usually the literature results for device-closure of patent oval foramen concern a single type of device or different devices implanted without anatomical preferences. We propose a strategy of device type and selection based on intra-cardiac echocardiography measurements of inter-atrial septum characteristics.
We prospectively enrolled 100 consecutive patients with a mean age of 43 plus or minus 15.5 years, 68 females, who had been referred to our centre for catheter-based closure of inter-atrial shunts over a 48-month period. On the basis of intra-cardiac echocardiography findings the operators selected the Amplatzer Occluder family (AGA Medical Corporation) or the Premere Closure System (St Jude Medical Inc.). Determinants of the selection process were presence and extension of atrial septal aneurysm, tunnel length, rims length, and thickness, presence of additional fenestrations.
According on intra-cardiac echocardiography study, 26 patients have a long channel patent oval foramen, 44 patients had a large atrial septal aneurysm (more than four RL), 24 patients had a moderate atrial septal aneurysm (more than two RL but less than four right-to-left), and six patients had hypertrophic rims. Thus, the Amplatzer PFO Occluder was selected in 24 patients, the Amplatzer ASD Cribriform Occluder in 44 patients, and the Premere device in 32 cases. No aortic erosions, device thrombosis, or recurrent ischaemic cerebral events were observed. Pre-discharge and follow-up occlusion rates were 91% and 96%, respectively.
Our study suggested that such strategy driven from identification and measurements of the right atrium and inter-atrial septum components resulted in low complications and high-success rates, mandatory conditions when facing with otherwise healthy subjects, such as the patients with patent oval foramen.
通常，关于卵圆孔未闭封堵器治疗的文献结果涉及单一类型的封堵器或在无解剖学偏好情况下植入的不同封堵器。我们提出一种基于心内超声心动图测量房间隔特征的封堵器类型及选择策略。
我们前瞻性纳入了100例连续患者，平均年龄43±15.5岁，其中68例为女性，这些患者在48个月期间因基于导管的房间隔分流封堵术被转诊至我们中心。根据心内超声心动图检查结果，术者选择了Amplatzer封堵器系列（AGA医疗公司）或Premere封堵系统（圣犹达医疗公司）。选择过程的决定因素包括房间隔瘤的存在及范围、隧道长度、边缘长度和厚度、额外筛孔的存在情况。
根据心内超声心动图研究，26例患者有长通道型卵圆孔未闭，44例患者有大的房间隔瘤（超过4个右房内径），24例患者有中度房间隔瘤（超过2个右房内径但小于4个右房内径），6例患者有肥厚边缘。因此，24例患者选择了Amplatzer卵圆孔未闭封堵器，44例患者选择了Amplatzer房间隔缺损筛孔状封堵器，32例患者选择了Premere封堵器。未观察到主动脉侵蚀、封堵器血栓形成或复发性缺血性脑事件。出院前和随访时的封堵成功率分别为91%和96%。
我们的研究表明，这种基于右心房和房间隔组成部分的识别与测量所驱动的策略导致并发症发生率低且成功率高，这是面对如卵圆孔未闭患者这类健康受试者时的必要条件。
