经导管房间隔缺损封堵术——球囊测量还必需吗？

Transcatheter closure of atrial septal defects--is balloon sizing still necessary?

机构信息

Department of Paediatrics, National University of Singapore, Singapore.

出版信息

Ann Acad Med Singap. 2010 May;39(5):390-3.

PMID:20535430

Abstract

INTRODUCTION

The device closure of atrial septal defects has evolved over the years. In the early days of transcatheter occlusion, balloon sizing was used to choose an appropriate sized device. We postulate that balloon sizing does not value-add to the procedure and is unnecessary.

MATERIALS AND METHODS

Patients who had balloon sizing, with (Group 1, n = 38) or without (Group 2, n = 21) atrial septal defect closure, were compared to another group (Group 3, n = 64) who had atrial septal defect closure without balloon sizing. Although the atrial septal defect size (mm) in those without balloon sizing (Group 3) compared to patients who had balloon sizing (Group 1) (18.3 +/- 5.4 vs 14.8 +/- 5.8; P = 0.021) was larger, the Amplatzer septal occluder size chosen (mm) (21.6 +/- 6.3 vs 21.2 +/- 8.1; P = 0.693) was similar.

RESULTS

We analysed the degree of absolute sizing, defined as [(Balloon or Amplatzer occluder size) - (transoesophageal echocardiography size)], versus relative sizing, which is defined as [(Balloon or Amplatzer occluder size)--(transoesophageal echocardiography size) / (Balloon or Amplatzer occluder size)]. It was evident that there was greater absolute and relative over-sizing (6.3 +/- 4.4 mm vs 4.2 +/- 2.1 mm; P = 0.009 and 28.3 +/- 15.4% vs 20.0 +/- 7.0%; P = 0.001, respectively) in patients with balloon sizing (Group 1) compared to those who did not (Group 3). Even a greater degree of absolute (5.1 +/- 3.9 mm vs 9.5 +/- 4.7 mm; P <0.001) and relative over-sizing (24.8 +/- 15.6% vs 33.0 +/- 13.6%; P = 0.001) was observed in patients who had balloon sizing but there was no closure (Group 2) compared to those who had balloon sizing and closure of their defects (Group 1).

CONCLUSION

Our results showed that balloon sizing tended to over-size the atrial septal defect. This may have an important bearing in selecting a larger device than necessary, or even precluding transcatheter closure of the larger atrial septal defects. It is also associated with increased procedural, fluoroscopy time and cost. We suggest that balloon sizing may no longer be necessary in the protocol of device closure of an atrial septal defect.

摘要

简介

多年来，房间隔缺损的器械闭合技术已经发展。在经导管封堵的早期，使用球囊测量来选择合适尺寸的器械。我们假设球囊测量并不能为手术增加价值，因此是不必要的。

材料与方法

比较了有（第 1 组，n = 38）或无（第 2 组，n = 21）球囊测量的房间隔缺损患者与另一组（第 3 组，n = 64）无球囊测量的房间隔缺损患者。尽管无球囊测量组（第 3 组）的房间隔缺损直径（mm）[18.3 ± 5.4 比 14.8 ± 5.8；P = 0.021]大于有球囊测量组（第 1 组），但所选的 Amplatzer 房间隔封堵器直径（mm）[21.6 ± 6.3 比 21.2 ± 8.1；P = 0.693]相似。

结果

我们分析了绝对尺寸，定义为 [(球囊或 Amplatzer 封堵器尺寸) - (经食管超声心动图尺寸)]，与相对尺寸，定义为 [(球囊或 Amplatzer 封堵器尺寸) - (经食管超声心动图尺寸) / (球囊或 Amplatzer 封堵器尺寸)]。显然，在有球囊测量（第 1 组）的患者中，绝对和相对过度尺寸（6.3 ± 4.4 毫米比 4.2 ± 2.1 毫米；P = 0.009 和 28.3 ± 15.4% 比 20.0 ± 7.0%；P = 0.001）更大，与无球囊测量（第 3 组）的患者相比。即使在有球囊测量但未闭合（第 2 组）的患者中，也观察到更大的绝对（5.1 ± 3.9 毫米比 9.5 ± 4.7 毫米；P <0.001）和相对过度尺寸（24.8 ± 15.6% 比 33.0 ± 13.6%；P = 0.001），与有球囊测量和房间隔缺损闭合的患者（第 1 组）相比。