Boon Isabelle, Vertongen Katrien, Paelinck Bernard P, Demulier Laurent, Van Berendoncks An, De Maeyer Catherine, Marchau Fabienne, Panzer Joseph, Vandekerckhove Kristof, De Wolf Daniel
Ghent University, Sint Pietersnieuwstraat 33, 9000, Ghent, Belgium.
Department of Cardiac Surgery, UZA, Wilrijkstraat 10, 2650, Edegem, Belgium.
Pediatr Cardiol. 2018 Jan;39(1):168-175. doi: 10.1007/s00246-017-1743-1. Epub 2017 Sep 27.
Percutaneous closure is the treatment of choice for secundum-type atrial septal defects (ASD). Balloon sizing (BS) has been the method of choice for deciding on device size. Improved 2D- and 3D-transesophageal echocardiographic (TEE) imaging challenged the necessity of BS. Balloon sizing was performed with two additional techniques to measure the stretched dimension of the ASD. The 1st method uses a stiff guide wire which stretches the ASD and 2D TEE. The second technique uses 3D TEE. Two hundred and thirty-six patients with minimum 1-year follow-up were enrolled. The population was classified into three groups: BS (group 1) n = 90, 2D-TEE (group 2) n = 87, and 3D-TEE (group 3) n = 59. All groups showed a distinct correlation between the maximum baseline dimensions and the device size (R = 0.821). The relative expansion rate did not differ between BS and 3D-TEE. Group 2 (2D-TEE) showed a significantly lower expansion rate. Procedural success and complications did not differ statistically between the 3 groups. 2D TEE sizing was the simplest method without loss of accuracy. 3D sizing offers the advantage of accurate and fast shape assessment, but resulted in more undersizing. Accurate sizing of ASDs with a floppy septum remains a challenge.
经皮封堵术是继发孔型房间隔缺损（ASD）的首选治疗方法。球囊测量（BS）一直是决定器械尺寸的首选方法。二维和三维经食管超声心动图（TEE）成像技术的改进对球囊测量的必要性提出了挑战。采用另外两种技术进行球囊测量以评估ASD的伸展尺寸。第一种方法使用硬导丝拉伸ASD并结合二维TEE。第二种技术使用三维TEE。纳入了236例至少随访1年的患者。将研究人群分为三组：球囊测量组（第1组）n = 90例，二维TEE组（第2组）n = 87例，三维TEE组（第3组）n = 59例。所有组的最大基线尺寸与器械尺寸之间均呈现显著相关性（R = 0.821）。球囊测量组与三维TEE组的相对扩张率无差异。第2组（二维TEE组）的扩张率显著较低。三组之间的手术成功率和并发症在统计学上无差异。二维TEE测量是最简单的方法且不损失准确性。三维测量具有准确快速评估形状的优势，但导致更多尺寸过小的情况。对于柔软房间隔的ASD进行准确测量仍然是一项挑战。
