Scheidmann Roman, Paul Thomas, Sigler Matthias
Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Centre, Georg-August-University, Robert-Koch-Str. 40, D-37075, Göttingen, Germany.
Mol Cell Pediatr. 2017 Nov 3;4(1):9. doi: 10.1186/s40348-017-0077-7.
Transcatheter closure has become the treatment of choice for secundum atrial septal defects (ASD II), but particularly in small children, there is concern regarding procedure-related complications.
We report on a 10-month-old infant, body weight of 6.4 kg, with a large ASD who was referred for failure to thrive and dyspnea on exertion. Echocardiography showed two neighboring ASDs centrally located within an atrial septum with a length of 27 mm resulting in significant left-to-right shunting. During cardiac catheterization, hemodynamic significance of the defect as well as normal pulmonary vascular resistance was demonstrated. Balloon sizing of the central ASD showed a stretched defect diameter of 12 × 11 mm. A 20-mm GORE CARDIOFORM septal occluder (GCSO; Goremedical, W. L. Gore & Associates, Inc., Newark, DE, USA) was implanted without any complications. Initial trivial residual shunting resolved during 4 months of follow-up. Right ventricular dimensions declined significantly, and the boy gained body weight properly.
DISCUSSION, EVALUATION AND CONCLUSION: As demonstrated in our report, even large ASDs can be closed safely by catheter intervention in small infants. Selection of implant device and optimal sizing is of paramount importance. The size of the delivery sheath (11 French in our patient) is a potential limitation for the GCSO in smaller infants.
经导管封堵术已成为继发孔型房间隔缺损（ASD II）的首选治疗方法，但特别是在幼儿中，人们对与手术相关的并发症存在担忧。
我们报告了一名10个月大、体重6.4千克的婴儿，患有大型ASD，因发育不良和活动时呼吸困难前来就诊。超声心动图显示，在房间隔中央有两个相邻的ASD，长度为27毫米，导致明显的左向右分流。心导管检查显示了该缺损的血流动力学意义以及正常的肺血管阻力。对中央ASD进行球囊测量显示，拉伸后的缺损直径为12×11毫米。植入了一个20毫米的GORE CARDIOFORM房间隔封堵器（GCSO；美国特拉华州纽瓦克市W. L. Gore & Associates公司的Goremedical产品），没有出现任何并发症。最初的轻微残余分流在4个月的随访中消失。右心室尺寸显著减小，患儿体重正常增加。
讨论、评估与结论：正如我们的报告所示，即使是大型ASD，在小婴儿中也可通过导管介入安全封堵。选择植入装置和最佳尺寸至关重要。输送鞘管的尺寸（我们的患者为11法式）对于较小婴儿使用GCSO来说是一个潜在限制。
