Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
EuroIntervention. 2016 Aug 5;12(5):e652-7. doi: 10.4244/EIJV12I5A106.
The feasibility of transcatheter closure of atrial septal defects (ASD) without fluoroscopy has been proven. However, the technique has not been accepted for routine use. We report our experience with trans-catheter closure of ASD without fluoroscopy and introduce a well-established technique for alternative use in children.
From November 2013 to May 2015, a total of 114 children with isolated secundum ASD (diameter 6 mm to 24 mm, median 13.8 mm) underwent attempted transcatheter device closure under the guidance of transoesophageal echocardiography without fluoroscopy. Using a modified delivery system and procedure technique, ASD were successfully closed in 110 patients (96.5%, 52 males, 58 females, aged from three to 14 years, median 5.4 years, weight 12 to 46 kg, median 23.5 kg). Procedure time ranged from eight to 42 minutes (median 18 min). Three patients underwent percardiac device closure after failed procedures. In the early stage of our study, before delivery system and technique modification, one patient was converted to open heart surgery due to rupture of the left appendage. No intervention-related complications were detected during a median follow-up of nine months.
Using a modified delivery system and a re-established procedure, we showed that transcatheter closure of ASD without fluoroscopy is a safe technique for alternative use in children.
经导管关闭房间隔缺损（ASD）而无需透视的可行性已得到证实。然而，该技术尚未被常规采用。我们报告了我们在 ASD 经导管无透视关闭方面的经验，并介绍了一种在儿童中替代使用的成熟技术。
从 2013 年 11 月至 2015 年 5 月，共有 114 例孤立性继发 ASD（直径 6 毫米至 24 毫米，中位数 13.8 毫米）在经食管超声心动图引导下尝试进行经导管器械关闭，而无需透视。使用改良的输送系统和程序技术，110 例患者（96.5%，52 名男性，58 名女性，年龄 3 至 14 岁，中位数 5.4 岁，体重 12 至 46 公斤，中位数 23.5 公斤）ASD 成功关闭。手术时间从 8 分钟到 42 分钟不等（中位数 18 分钟）。3 例患者在经心腔内器械关闭失败后进行了心包内器械关闭。在我们研究的早期，在输送系统和技术改良之前，由于左心耳破裂，1 例患者转为开胸手术。在中位数为 9 个月的随访期间，未发现与干预相关的并发症。
使用改良的输送系统和重新建立的程序，我们表明，经导管 ASD 无透视关闭是一种在儿童中替代使用的安全技术。
