Service de cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes - M3C, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France.
Service de cardiologie pédiatrique, centre de référence malformations cardiaques congénitales complexes - M3C, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris Descartes, 75006 Paris, France.
Arch Cardiovasc Dis. 2018 Mar;111(3):189-198. doi: 10.1016/j.acvd.2017.05.011. Epub 2017 Oct 31.
Cardiac catheterization relies on X-ray imaging. Most procedures are now standardized. Interventionists must strive to minimize radiation exposure to reduce the risk of induced cancers.
To describe the radiation level in our institution, and evaluate the components contributing to radiation exposure, during transcatheter atrial septal defect (ASD) closure.
Radiation doses for ASD closure performed between January 2009 and November 2015 were reviewed retrospectively. Data on fluoroscopic time, dose area product (DAP), DAP/kg of body weight and total air kerma were collected.
One hundred and seventy-four consecutive patients were included. Procedural success was 98.3%. Median procedural and fluoroscopic times were 15minutes and 1.2minutes, respectively. Median total air kerma, DAP and DAP/kg were 9.2 mGy, 88.3μGy.m and 3.2μGy.m/kg, respectively. Risk factors associated with higher DAP were older age, larger ASD and device, need for balloon calibration, occurrence of complications and use of higher frame rate. Reduction of frame rate to 7.5 frames/second alone reduced by a factor of 2 the median DAP, DAP/kg and air kerma (99 vs 43μGy.m, 3.5 vs 1.7μGy.m/kg and 11 vs 4.8 mGy, respectively; P<0.001).
A low dose of radiation can be achieved for transcatheter ASD closure, even in complex ASDs, by following these recommendations: reduction of frame rate; avoidance of lateral view and cine acquisition; and limitation of fluoroscopic time by avoiding unnecessary manoeuvres and using echocardiographic guidance as much as possible.
心脏导管检查依赖于 X 射线成像。目前大多数程序已经标准化。介入医师必须努力将辐射暴露最小化，以降低诱导癌症的风险。
描述我们机构的辐射水平，并评估在经导管房间隔缺损（ASD）封堵术中导致辐射暴露的各个组成部分。
回顾性分析 2009 年 1 月至 2015 年 11 月期间进行的 ASD 封堵术的辐射剂量。收集透视时间、剂量面积乘积（DAP）、DAP/体重和总空气比释动能的数据。
共纳入 174 例连续患者。手术成功率为 98.3%。中位数手术和透视时间分别为 15 分钟和 1.2 分钟。中位数总空气比释动能、DAP 和 DAP/体重分别为 9.2 mGy、88.3 μGy.m 和 3.2 μGy.m/kg。与 DAP 较高相关的危险因素是年龄较大、ASD 较大和器械较大、需要气球校准、发生并发症和使用较高的帧率。仅将帧率降低到 7.5 帧/秒就将中位数 DAP、DAP/体重和空气比释动能降低了 2 倍（99 对 43 μGy.m、3.5 对 1.7 μGy.m/kg 和 11 对 4.8 mGy，分别为 P<0.001）。
通过遵循以下建议，可以为经导管 ASD 封堵术实现低剂量辐射：降低帧率；避免侧位视图和电影采集；并通过避免不必要的操作和尽可能使用超声心动图引导来限制透视时间，从而限制氟辐射暴露。
