Mulukutla Venkatachalam, Qureshi Athar M, Pignatelli Ricardo, Ing Frank F
Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, 77030, USA.
Division of Cardiology, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS #34, Los Angeles, CA, 90027, USA.
Pediatr Cardiol. 2018 Mar;39(3):445-449. doi: 10.1007/s00246-017-1771-x. Epub 2017 Nov 15.
The aim of this study was to define characteristics of those patients who are referred for device closure of an Atrial septal defect (ASD), but identified to "crossover" surgery. All patients who underwent surgical and device (Amplatzer or Helex occluder) closures of secundum ASDs from 2001 to 2010 were reviewed and organized into three groups: surgical closure, device closure, and "crossover" group. 369 patients underwent ASD closure (265 device, 104 surgical). 42 of the 265 patients referred for device closure "crossed over" to the surgical group at various stages of the catheterization procedure. The device group had defect size measuring 14.2 mm (mean) and an ASD index (Defect Size (mm)/BSA) of 14.0 compared to the corresponding values in the surgical group (20.1 mm, ASD index 25.9) (P < 0.001) and in the "crossover" group (20.7 mm, 22.6 ASD index) (P < 0.001). 79 patients in the device group had a deficient rim, and 86% were located in the retroaortic region. 33 patients in the "crossover" group had deficient rims with 70% deficiency in the posterior/inferior rim. The device group with deficient rims had an ASD index of 14.7 compared with the crossover group ASD index of 23.8 (P < 0.001). Comparing the device and "crossover" groups, an ASD index greater than 23.7 had a 90% specificity in "crossing over" to surgery. The crossover and surgical groups had statistically larger ASD defect size indexes compared with the device group. Deficient rim in the posterior/inferior rim is associated with a large ASD size index which is a predictive factor for crossing over to surgery. Catheterization did not negatively impact surgical results in the "crossover" group.
本研究的目的是明确那些因房间隔缺损（ASD）而被推荐进行器械封堵，但最终确定需要“转归”手术的患者的特征。回顾了2001年至2010年间所有接受继发孔型ASD手术和器械（Amplatzer或Helex封堵器）封堵的患者，并将其分为三组：手术封堵组、器械封堵组和“转归”组。369例患者接受了ASD封堵（265例器械封堵，104例手术封堵）。在265例被推荐进行器械封堵的患者中，有42例在导管插入术的不同阶段“转归”到了手术组。器械封堵组的缺损大小平均为14.2mm，ASD指数（缺损大小（mm）/体表面积）为14.0，而手术组的相应值为（20.1mm，ASD指数25.9）（P<0.001），“转归”组为（20.7mm，ASD指数22.6）（P<0.001）。器械封堵组中有79例患者边缘不足，其中86%位于主动脉后区域。“转归”组中有33例患者边缘不足，其中70%为后下边缘不足。边缘不足的器械封堵组ASD指数为14.7，而“转归”组ASD指数为23.8（P<0.001）。比较器械封堵组和“转归”组，ASD指数大于23.7时，“转归”到手术的特异性为90%。与器械封堵组相比，“转归”组和手术组的ASD缺损大小指数在统计学上更大。后下边缘不足与较大的ASD大小指数相关，这是“转归”到手术的一个预测因素。在“转归”组中，导管插入术对手术结果没有负面影响。
