Toyama Kentaro, Rader Florian, Kar Saibal, Kubo Shunsuke, Shiota Takahiro, Nishioka Toshihiko, Siegel Robert J
The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
Am J Cardiol. 2018 Feb 15;121(4):475-479. doi: 10.1016/j.amjcard.2017.11.006. Epub 2017 Nov 24.
This study examines the incidence of iatrogenic atrial septal defect (iASD) after the MitraClip procedure and its influence on echocardiographic and clinical outcomes. We examined 96 patients who underwent a successful MitraClip procedure and who also had baseline and 1-year postprocedure transthoracic echocardiograms. At 1-year follow-up, iASD were observed in 24% of cases. Compared with the patients without iASD, the patients with iASD had a larger right atrium and greater severity of tricuspid regurgitation (TR) at baseline. After the MitraClip procedure, mitral regurgitation lessened significantly in both groups. Although right atrial area and right ventricular diameters increased significantly in patients with iASD (25.3 ± 8.0 to 28.3 ± 9.5 cm, 39.7 ± 7.1 to 42.2 ± 8.1 mm, p <0.05 for both comparisons), these variables did not change in patients without iASD. In addition, patients with iASD had worse TR at follow-up. The incidence of stroke was comparable between the 2 groups during 1-year follow-up (4.3% vs 4.1%). However, patients with iASD had a markedly higher re-hospitalization rate for heart failure (26% vs 2.7%, p <0.05). In conclusion, iASD occurred in 24% of patients who underwent the MitraClip therapy and the presence of iASD was associated with right-sided heart enlargement, worse TR, and a higher re-hospitalization rate for heart failure.
本研究探讨了MitraClip手术（二尖瓣缘对缘修复术）后医源性房间隔缺损（iASD）的发生率及其对超声心动图和临床结局的影响。我们研究了96例成功接受MitraClip手术且有基线和术后1年经胸超声心动图检查的患者。在1年随访时，24%的病例观察到iASD。与无iASD的患者相比，有iASD的患者在基线时右心房更大，三尖瓣反流（TR）更严重。MitraClip手术后，两组的二尖瓣反流均显著减轻。虽然有iASD的患者右心房面积和右心室直径显著增加（从25.3±8.0至28.3±9.5cm，从39.7±7.1至42.2±8.1mm，两组比较p均<0.05），但无iASD的患者这些变量没有变化。此外，有iASD的患者在随访时TR更严重。两组在1年随访期间的卒中发生率相当（4.3%对4.1%）。然而，有iASD的患者因心力衰竭再次住院的发生率明显更高（26%对2.7%，p<0.05）。总之，24%接受MitraClip治疗的患者发生了iASD，iASD的存在与右心扩大、更严重的TR以及更高的心力衰竭再次住院率相关。
