Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
Eur J Cardiothorac Surg. 2012 Feb;41(2):266-71. doi: 10.1016/j.ejcts.2011.05.045. Epub 2011 Dec 12.
We introduced a new atrial septum remodeling technique and further investigated the feasibility of this method in facilitating the intra-operative device closure (IODC) of multiple atrial septal defects (ASDs).
Adult patients with multiple nearby ASDs, which were not eligible for transcatheter closure, were enrolled in this study. Transesophageal echocardiogram (TEE) was applied for intra-operative evaluation. The multiple ASDs were divided into three different types according to its morphology. Based on the concept of breaking the rim between multiple ASDs and making it feasible for single device closure, atrial septum remodeling procedure was carried out via pre-atrial approach using special clamp under the guidance of TEE. IODC was then attempted for reshaped ASD. Successful rate and perioperative complications were then noted.
Eleven patients were enrolled in this study, with mean age being 23.4 ± 5.3 years and mean weight 51.6 ± 8.0 kg. Among them, seven patients have double ASDs and four have triple ASDs. Mean diameter of isolated ASD was 10.4 ± 3.8 mm with a mean distance of 3.2 ± 1.2 mm between each other. Atrial septum remodeling procedure was successfully done in all patients. One device was then used for each patient. Mean ASD diameter after remodeling procedure was 20.6 ± 3.9 mm with mean device size 23.5 ± 4.0 mm. Complete closure of multiple ASDs was achieved in nine patients immediately after the procedure; two patients had trivial grade shunt after device deployment that resolved within the 3-month follow-up. No severe complications were noticed during the perioperative period and the 3-month follow-up.
Atrial septum remodeling technique seems to be a safe and effective method that could largely facilitate the successful IODC of multiple ASDs.
我们介绍了一种新的房间隔重塑技术，并进一步研究了该方法在促进多个房间隔缺损（ASD）的术中器械闭合（IODC）中的可行性。
本研究纳入了多个邻近 ASD 且不适合经导管闭合的成年患者。术中采用经食管超声心动图（TEE）进行评估。根据其形态将多个 ASD 分为三种不同类型。基于打破多个 ASD 边缘并使其能够进行单一器械闭合的理念，在 TEE 引导下，采用特殊夹具通过心房前入路进行房间隔重塑术。然后尝试对重塑后的 ASD 进行 IODC。记录成功率和围手术期并发症。
本研究纳入了 11 例患者，平均年龄为 23.4 ± 5.3 岁，平均体重为 51.6 ± 8.0 kg。其中 7 例患者有双 ASD，4 例患者有三 ASD。孤立 ASD 的平均直径为 10.4 ± 3.8 mm，彼此之间的平均距离为 3.2 ± 1.2 mm。所有患者均成功完成了房间隔重塑术。每位患者均使用一个器械。重塑术后 ASD 的平均直径为 20.6 ± 3.9 mm，平均器械尺寸为 23.5 ± 4.0 mm。术后即刻 9 例患者的多个 ASD 完全闭合；2 例患者在器械放置后出现轻微分流，在 3 个月随访时消失。围手术期和 3 个月随访期间未出现严重并发症。
房间隔重塑技术似乎是一种安全有效的方法，可以大大促进多个 ASD 的成功 IODC。
