Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Taiwan University & Hospital, Taipei, Taiwan, ROC.
Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2017 Jun;80(6):333-340. doi: 10.1016/j.jcma.2017.03.003. Epub 2017 Apr 25.
The anatomy of septal defects can be complex and morphologically unpredictable. Balloon sizing of such defects may not be feasible, and an appropriately sized commercial occluder may not be available. Therefore, percutaneous transcatheter closure of such defects can be challenging because of an increased risk of complications. In this study, we have described the efficacy and safety of transcatheter closure of complex septal defects using Amplatzer cribriform occluder devices, assessed by real time three-dimensional (RT 3D) color Doppler transesophageal echocardiography (TEE).
Four complex septal defects were involved in this investigation: (1) reimplanted multiple atrial septal defects (ASD) with one device embolization; (2) postinfarction ventricular septal defect; (3) long tunnel patent foramen ovale; and (4) postoperative residual ASD. All patients underwent percutaneous transcatheter interventions due to the high risk of surgical complications, and one of the three available cribriform ASD device sizes (18 mm, 25 mm, or 35 mm) was implanted. Perioperative RT 3D TEE combined with fluoroscopy was used for monitoring during the procedure. All defects were successfully occluded by cribriform septal occluder devices using the transcatheter technique.
Our patients with complex septal defects were successfully treated by transcatheter closure using an Amplazter cribriform septal occluder device with careful planning based on patient presentation and close interdisciplinary collaboration. RT 3D color Doppler TEE provided precise information for the selection of the appropriate occluder device and facilitated the procedure by guiding the catheter through the often challenging patient anatomy.
间隔缺损的解剖结构可能很复杂，形态难以预测。此类缺陷的球囊测量可能不可行，也可能无法获得尺寸合适的商业封堵器。因此，由于并发症风险增加，此类缺陷的经皮导管介入封堵可能具有挑战性。在这项研究中，我们通过实时三维（RT 3D）彩色多普勒经食管超声心动图（TEE）评估，描述了使用 Amplatzer 筛状封堵器装置经导管治疗复杂间隔缺损的疗效和安全性。
本研究涉及 4 例复杂间隔缺损：（1）用 1 个封堵器栓塞再植入的多发房间隔缺损（ASD）；（2）梗死后室间隔缺损；（3）长隧道卵圆孔未闭；（4）术后残余 ASD。所有患者均因手术并发症风险高而接受经皮导管介入治疗，其中 3 种可用的筛状 ASD 装置尺寸（18mm、25mm 或 35mm）之一被植入。术中监测采用经胸实时 3D TEE 与透视相结合。所有缺陷均通过经导管技术成功用筛状间隔封堵器装置封堵。
我们的复杂间隔缺损患者通过使用 Amplatzer 筛状间隔封堵器装置进行经导管治疗取得了成功，治疗方案是基于患者表现并密切进行跨学科协作而精心制定的。RT 3D 彩色多普勒 TEE 为选择合适的封堵器装置提供了精确信息，并通过引导导管穿过通常具有挑战性的患者解剖结构，为手术提供便利。
