Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Thorac Cardiovasc Surg. 2019 Apr;157(4):1603-1608. doi: 10.1016/j.jtcvs.2018.11.093. Epub 2018 Dec 12.
Transcatheter closure is usually contraindicated in secundum atrial septal defect with no rim to right pulmonary vein. The morphology of an atrial septal defect is special in these patients, and the off-label use of a duct occluder might make transcatheter closure possible with the assistance of a personalized heart model. However, the related data are absent. This study was performed to investigate the off-label use of a duct occluder in the transcatheter closure of an atrial septal defect with no right pulmonary vein rim.
Seven consecutive patients with an atrial septal defect (2 male/5 female; 40.1 ± 15.2 years) with no right pulmonary vein rim were referred for attempted transcatheter closure, and a personalized heart model was produced on the basis of multislice computed tomography images. With the elastic heart model, in vitro trial occlusion was performed with a duct occluder for preoperative evaluation, and the results were compared with postoperative outcomes.
A single atrial septal defect was identified in 6 patients, and a double atrial septal defect was identified in another patient (1 atrial septal defect with no right pulmonary vein rim and 1 with sufficient surrounding rims). The size of the atrial septal defect was 13.4 ± 2.2 mm, and the in vitro balloon-stretched diameter was 20.2 ± 3.2 mm in the heart model. In vitro trial occlusion was achieved in all patients, and subsequent in vivo transcatheter closure was performed successfully with the duct occluder of the same size (24.3 ± 3.1 mm). During follow-up (1.57 ± 0.84 years), mild pericardial effusion was identified in 2 patients and disappeared within 3 months. No other complications occurred.
By using a personalized heart model, the off-label use of a duct occluder is feasible and safe in the transcatheter closure of an atrial septal defect with no right pulmonary vein rim. Further research is required to evaluate the long-term outcomes.
通常不建议在无右肺静脉边缘的继发房间隔缺损中进行经导管闭合。这些患者的房间隔缺损形态特殊，在个性化心脏模型的辅助下，使用导管塞可能可以实现经导管闭合，但相关数据尚缺乏。本研究旨在探讨无右肺静脉边缘房间隔缺损的经导管闭合中使用导管塞的适应证外使用。
连续 7 例无右肺静脉边缘的房间隔缺损患者（2 例男性/5 例女性；40.1±15.2 岁）被转诊进行尝试经导管闭合，并基于多层计算机断层扫描图像制作个性化心脏模型。使用弹性心脏模型，对导管塞进行体外试封堵，进行术前评估，并将结果与术后结果进行比较。
6 例患者中发现单个房间隔缺损，另 1 例患者发现双房间隔缺损（1 个房间隔缺损无右肺静脉边缘，1 个有足够的周围边缘）。房间隔缺损的大小为 13.4±2.2mm，心脏模型中球囊扩张后的直径为 20.2±3.2mm。所有患者均能进行体外试封堵，随后使用相同大小的导管塞（24.3±3.1mm）成功进行体内经导管闭合。在随访（1.57±0.84 年）期间，2 例患者出现轻度心包积液，3 个月内消失。无其他并发症发生。
使用个性化心脏模型，在无右肺静脉边缘的房间隔缺损的经导管闭合中，导管塞的适应证外使用是可行且安全的。需要进一步研究评估长期结果。
