Knop Mateusz, Szkutnik Małgorzata, Fiszer Roland, Białkowska Beata, Głowacki Jan, Białkowski Jacek
Śląski Uniwersytet Medyczny.
Cardiol J. 2014;21(3):279-83. doi: 10.5603/CJ.a2013.0120. Epub 2013 Aug 30.
Transcatheter closure of atrial septal defect (ASD) in older children and adults is currently considered the first-choice therapeutic option. This approach remains challenging in younger children. The aim of the study was to evaluate feasibility, safety and midterm efficacy of percutaneous ASD closure in symptomatic infants ≤10 kg body weight in our institution.
There were 28 children up to 10 kg of body weight, who were qualified for transcatheter closure of ASD. All patients but one showed overload of right atrium and right ventricle. Mean weight of patients who underwent transcatheter closure was 9.2 ± 0.88 kg and age 1.59 ± 0.58 years, respectively. Transcatheter closure of ASD was conducted using Amplatzer occluders (ASO).
The devices were implanted successfully in 26/28 patients (93%). In 2 (7%) children the device repeatedly straddled the septum in relatively big ASD and the procedure was abandoned. Mean ASD diameter in patients, who underwent transcatheter closure, was 9.08 ± 2.9 mm (transthoracic echocardiography) and mean implant size/weight ratio was 1.07 ± 0.31. In the child with right-left shunt through ASD normalization of saturation occurred. Mean fluoroscopy time was 4.16 min. In 3 children minor complications occurred: transient arrhythmias (n = 1), fever after procedure (n = 2). The follow-up time was 6.1 (range 1.2-11) years. At follow-up, clinical condition and/or growth improved in all patients except 4 children with coexisting comorbidity. No arrhythmia nor conduction disturbances were observed during follow-up.
In selected patients weighing less or equal to 10 kg, percutaneous closure of ASD is a safe and effective procedure.
经导管封堵大龄儿童和成人的房间隔缺损（ASD）目前被认为是首选治疗方案。在年幼儿童中，这种方法仍然具有挑战性。本研究的目的是评估在我院对体重≤10kg的有症状婴儿进行经皮ASD封堵术的可行性、安全性和中期疗效。
有28名体重达10kg的儿童符合经导管封堵ASD的条件。除1名患者外，所有患者均表现为右心房和右心室负荷过重。接受经导管封堵术的患者平均体重为9.2±0.88kg，平均年龄为1.59±0.58岁。使用Amplatzer封堵器（ASO）进行ASD的经导管封堵。
26/28例患者（93%）成功植入封堵器。2例（7%）儿童因ASD较大，封堵器反复跨隔，手术放弃。接受经导管封堵术的患者ASD平均直径为9.08±2.9mm（经胸超声心动图测量），平均植入尺寸/体重比为1.07±0.31。通过ASD发生右向左分流的患儿饱和度恢复正常。平均透视时间为4.16分钟。3例儿童出现轻微并发症：短暂性心律失常（1例）、术后发热（2例）。随访时间为6.1年（范围1.2 - 11年）。随访时，除4例合并其他疾病的儿童外，所有患者的临床状况和/或生长情况均有改善。随访期间未观察到心律失常或传导障碍。
对于体重≤10kg的特定患者，经皮封堵ASD是一种安全有效的手术。
