Ananthakrishna Pillai Ajith, Upadhyay Amarnath, Gousy Saranya, Handa Amit
Department of Cardiology,Jawaharlal Institute of Post-Graduate Medical Education and Research,Puducherry,India.
Cardiol Young. 2018 Oct;28(10):1122-1133. doi: 10.1017/S1047951118001099. Epub 2018 Jul 23.
The outcome of transcatheter closure in ostium secundum atrial septal defects is determined by the morphology of the defects. Modified techniques such as balloon assistance, pulmonary vein deployment, left atrial roof technique, and so on are used for circumventing the anatomic complexities and increasing the success rates.
We planned a prospective study looking at the outcomes of transcatheter closure in secundum atrial septal defects with modified techniques in different anatomic complexities identified in transoesophageal echocardiography and their association with outcome of transcatheter closure.
Transcatheter closure was successful in 295 out of 346 (82%) patients with modified techniques. Balloon-assisted technique offered a success rate of 87%. The mean defect size was 34.7±2.78 mm (95% confidence interval (CI) 30.67-43.1 mm) with success and 40.16±4.5 mm (95% CI 32.16-44.7) with failure (p = 0.02). The mean total septal length was 38.11±0.63 (95% CI 35.21-40.56 mm) with success and 42.54±0.34 (95% CI 38.79-43.21 mm) with failure. The defect to septal ratios were 0.82 and 0.94 in success and failure groups, respectively (p=0.02). However, the absence of a retro-aortic margin, septal aneurysm, and multiple defects did not affect the success rate. Deficient inferior vena caval margin, deficient posterior margin, and size⩾40 mm had a high risk of failure with transcatheter closure. The odds ratio for procedural failure was 25.3 (4.3-143.8) in patients with malaligned septum, 8.3(1.4-48.5) with deficient inferior vena caval margin, and 4.1(2.5-19) for size⩾40 mm.
The modified techniques for device deployment offer substantial chances of success in transcatheter closure of secundum atrial septal defects with anatomical complexity (82%). Variants such as defect size of⩾40 mm and deficient inferior and posterior margins have high failure rates with a modified technique.
继发孔型房间隔缺损经导管封堵术的疗效取决于缺损的形态。采用球囊辅助、肺静脉置入、左心房顶部技术等改良技术来规避解剖结构的复杂性并提高成功率。
我们计划进行一项前瞻性研究，观察在经食管超声心动图确定的不同解剖复杂性的继发孔型房间隔缺损中采用改良技术进行经导管封堵术的疗效，以及这些因素与经导管封堵术疗效的相关性。
346例患者中，295例（82%）采用改良技术经导管封堵成功。球囊辅助技术的成功率为87%。封堵成功患者的平均缺损大小为34.7±2.78 mm（95%置信区间[CI] 30.67 - 43.1 mm），封堵失败患者为40.16±4.5 mm（95% CI 32.16 - 44.7）（p = 0.02）。封堵成功患者的平均房间隔总长度为38.11±0.63（95% CI 35.21 - 40.56 mm），封堵失败患者为42.54±0.34（95% CI 38.79 - 43.21 mm）。成功组和失败组的缺损与房间隔比值分别为0.82和0.94（p = 0.02）。然而，无主动脉后缘、房间隔瘤和多发缺损并不影响成功率。下腔静脉缘不足、后缘不足以及缺损大小≥40 mm的患者经导管封堵失败风险较高。房间隔排列不齐的患者手术失败的比值比为25.3（4.3 - 143.8），下腔静脉缘不足的患者为8.3（1.4 - 48.5），缺损大小≥40 mm的患者为4.1（2.5 - 19）。
改良的封堵器置入技术为解剖结构复杂的继发孔型房间隔缺损经导管封堵术提供了较高的成功机会（82%）。缺损大小≥40 mm以及下腔静脉缘和后缘不足等情况采用改良技术时失败率较高。
