Praz Fabien, Wahl Andreas, Schmutz Mathieu, Pfammatter Jean-Pierre, Pavlovic Mladen, Perruchoud Stéphanie, Remondino Andrea, Windecker Stephan, Meier Bernhard
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
J Invasive Cardiol. 2015 Mar;27(3):157-62.
We sought to assess the safety and efficacy of percutaneous closure of atrial septal defects (ASDs) under fluoroscopic guidance only, without periprocedural echocardiographic guidance.
Percutaneous closure of ASDs is usually performed using simultaneous fluoroscopic and transthoracic, transesophageal (TEE), or intracardiac echocardiographic (ICE) guidance. However, TEE requires deep sedation or general anesthesia, which considerably lengthens the procedure. TEE and ICE increase costs.
Between 1997 and 2008, a total of 217 consecutive patients (age, 38 ± 22 years; 155 females and 62 males), of whom 44 were children ≤16 years, underwent percutaneous ASD closure with an Amplatzer ASD occluder (AASDO). TEE guidance and general anesthesia were restricted to the children, while devices were implanted under fluoroscopic guidance only in the adults. For comparison of technical safety and feasibility of the procedure without echocardiographic guidance, the children served as a control group.
The implantation procedure was successful in all but 3 patients (1 child and 2 adults; 1.4%). Mean device size was 23 ± 8 mm (range, 4-40 mm). There was 1 postprocedural complication (0.5%; transient perimyocarditis in an adult patient). At last echocardiographic follow-up, 13 ± 23 months after the procedure, 90% of patients had no residual shunt, whereas a minimal, moderate, or large shunt persisted in 7%, 1%, and 2%, respectively. Four adult patients (2%) underwent implantation of a second device for a residual shunt. During a mean follow-up period of 3 ± 2 years, 2 deaths and 1 ischemic stroke occurred.
According to these results, percutaneous ASD closure using the AASDO without periprocedural echocardiographic guidance seems safe and feasible.
我们试图评估仅在荧光镜引导下，而非围手术期超声心动图引导下经皮闭合房间隔缺损（ASD）的安全性和有效性。
经皮闭合ASD通常在荧光镜与经胸、经食管（TEE）或心内超声心动图（ICE）同时引导下进行。然而，TEE需要深度镇静或全身麻醉，这会显著延长手术时间。TEE和ICE会增加成本。
1997年至2008年期间，共有217例连续患者（年龄38±22岁；女性155例，男性62例）接受了经皮ASD封堵术，其中44例为16岁及以下儿童，使用Amplatzer ASD封堵器（AASDO）。TEE引导和全身麻醉仅限于儿童，而仅在荧光镜引导下为成人植入装置。为比较无超声心动图引导下手术的技术安全性和可行性，将儿童作为对照组。
除3例患者（1例儿童和2例成人；1.4%）外，植入手术均成功。平均装置尺寸为23±8mm（范围4-40mm）。术后有1例并发症（0.5%；1例成年患者发生短暂性心肌炎）。在术后13±23个月的最后一次超声心动图随访中，90%的患者无残余分流，而分别有7%、1%和2%的患者存在微量、中度或大量分流。4例成年患者（2%）因残余分流接受了第二次装置植入。在平均3±2年的随访期内，发生2例死亡和1例缺血性中风。
根据这些结果，使用AASDO在无围手术期超声心动图引导下经皮闭合ASD似乎是安全可行的。
