Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.
Catheter Cardiovasc Interv. 2013 Mar;81(4):654-9. doi: 10.1002/ccd.24500. Epub 2012 Nov 14.
To evaluate feasibility, efficacy, and safety of an approach to atrial septal defect (ASD) occlusion in children ≤20 kg that eliminates cardiac wall erosion risk.
Cardiac wall erosion is a potentially catastrophic complication of ASD device closure. The HELEX Septal Occluder (HSO) is a compliant device with no reports of erosion. The HSO is technically difficult to deploy in smaller children and cannot be used to close larger defects. To eliminate wall erosion risk, we use the HSO when feasible and surgery for larger defects.
Retrospective review of ASD procedures performed in children ≤20 kg.
Between January 2006 and January 2011, 60 children underwent ASD closure. HSO placement was successful in 32 of 34 patients, and surgical closure was successful in all of 28 patients. Surgical patients were younger (35.1 ± 12.6 vs. 47.4 ± 15.3 months, P < 0.01) and smaller (15.3 ± 3.2 vs. 12.6 ± 4.3 kg; P < 0.01) with larger ASDs (15.8 ± 4.5 vs. 9.8 ± 3.0 mm; P < 0.01). No surgical patients demonstrated residual leak. Residual leak was seen in 14 of 32 (44%) HSO patients on postprocedure day #1 and in 1 of 26 (3.8%) with ≥6 months follow-up. Indications for surgery included: deficient inferior/superior rims (n = 17), provider preference (n = 2), and HSO device not feasible (n = 9). Serious adverse events included device embolization with percutaneous retrieval (n = 1) and postpericardiotomy syndrome without intervention (n = 1).
The HSO can be safely used in most children ≤20 kg. Our approach to ASD closure is associated with minimal morbidity and good short-term results. This approach requires no more than a 15% increase in surgical referrals and eliminates risk of cardiac wall erosion.
评估一种用于 ≤20kg 儿童房间隔缺损（ASD）封堵的方法的可行性、疗效和安全性，该方法可消除心脏壁侵蚀的风险。
心脏壁侵蚀是 ASD 装置封堵的一种潜在灾难性并发症。HELEX Septal Occluder（HSO）是一种顺应性装置，尚无侵蚀的报道。在较小的儿童中，HSO 的技术难度较大，无法用于封堵较大的缺损。为了消除壁侵蚀风险，对于较小的缺损，我们尽可能使用 HSO，对于较大的缺损，则采用手术。
回顾性分析 20kg 以下儿童 ASD 手术的病例。
2006 年 1 月至 2011 年 1 月，共有 60 名儿童接受 ASD 封堵术。34 名患者中，HSO 放置成功 32 例，28 名患者手术成功。手术组患者年龄较小（35.1±12.6 个月 vs. 47.4±15.3 个月，P＜0.01）、体重较轻（15.3±3.2kg vs. 12.6±4.3kg，P＜0.01），ASD 较大（15.8±4.5mm vs. 9.8±3.0mm，P＜0.01）。无手术患者有残余漏。HSO 患者在术后第 1 天有 14 例（44%）和 26 例中有 1 例（3.8%）在≥6 个月随访时存在残余漏。手术的适应证包括：下/上缘缺陷（n=17）、术者偏好（n=2）和 HSO 装置不可行（n=9）。严重不良事件包括经皮取出的器械栓塞（n=1）和无需干预的心包切开术后综合征（n=1）。
HSO 可安全用于大多数≤20kg 的儿童。我们的 ASD 封堵方法具有较低的发病率和良好的短期效果。该方法只需要增加不超过 15%的手术转诊率，且可消除心脏壁侵蚀的风险。
