Wang Jingjin, Patel Mehul, Xiao Minghu, Xu Zhongying, Jiang Shiliang, Sun Xin, Xu Liang, Wang Hao
Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
EuroIntervention. 2016 Jun 12;12(2):e250-6. doi: 10.4244/EIJV12I2A39.
Pericardial effusion (PE) without obvious periprocedural complications (e.g., cardiac perforation, device erosion) may occur after transcatheter closure of secundum atrial septal defects (ASD). The aim of the study was to investigate the incidence and predictors of PE unrelated to procedural complications.
We included all patients who had undergone successful percutaneous ASD closure from June 2009 to April 2014 (n=2,652) with no pre-existing PE or cardiac perforation or erosion. Transthoracic echocardiography (TTE) was performed during the procedure and one, three, and six months postoperatively. After device implantation, fifty patients (1.9%) developed new-onset PE (37 immediately, 13 during follow-up). These patients were asymptomatic, stable haemodynamically, and had no new arrhythmias. PE appeared mild (5.1±1.9 mm) and homogeneously echolucent by TTE. PE diminished spontaneously. Compared with 2,602 patients without PE, factors independently predicting asymptomatic PE were the device touching the atrial free wall, device size, patient age, and total defect size. Areas under the receiver operating characteristic curves were 0.78 (p<0.001), 0.66 (p<0.001) and 0.77 (p<0.001) for device size, patient age, and total defect size, respectively.
This is the first systematic report of a new type of PE. Our data provide new insights into new-onset PE after percutaneous ASD closure.
继发孔型房间隔缺损（ASD）经导管封堵术后可能发生无明显围手术期并发症（如心脏穿孔、装置侵蚀）的心包积液（PE）。本研究旨在调查与手术并发症无关的PE的发生率及预测因素。
我们纳入了2009年6月至2014年4月期间成功接受经皮ASD封堵术的所有患者（n = 2652），这些患者术前无PE、心脏穿孔或侵蚀。术中及术后1个月、3个月和6个月进行经胸超声心动图（TTE）检查。装置植入后，50例患者（1.9%）出现新发PE（37例立即出现，13例在随访期间出现）。这些患者无症状，血流动力学稳定，无新发心律失常。TTE显示PE较轻（5.1±1.9 mm）且回声均匀。PE自发减少。与2602例无PE的患者相比，独立预测无症状PE的因素为装置接触心房游离壁、装置大小、患者年龄和总缺损大小。装置大小、患者年龄和总缺损大小的受试者工作特征曲线下面积分别为0.78（p<0.001）、0.66（p<0.001）和0.77（p<0.001）。
这是关于新型PE的首份系统性报告。我们的数据为经皮ASD封堵术后新发PE提供了新的见解。
