Amedro Pascal, Bayburt Selin, Assaidi Anass, Kreitmann Bernard, Habib Gilbert, Fouilloux Virginie, Fraisse Alain
PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France.
J Thorac Dis. 2019 Mar;11(3):708-716. doi: 10.21037/jtd.2019.02.89.
Transcatheter closure for atrial septal defect (ASD) with inferior-posterior rim deficiency has been scarcely reported with proper identification of the indications and limits. We aimed to assess the safety and feasibility of transcatheter closure of ASDs with deficient rims, paying particular attention to cases with inferior-posterior rim deficiency.
From January 2008 to January 2013, 241 patients underwent transcatheter ASD closure, including 50 cases (20.7%) with deficient rims, other than the anterior-superior one. Eighteen patients (12 females) presented inferior-posterior rim deficiency. Their median age was 8 (1.4-85) years and their median weight was 24 [9-97] kg. Transcatheter closure was performed in all cases under transesophageal echocardiography (TEE) guidance in children and intracardiac echocardiography (ICE) guidance in adults.
Out of 18 patients with inferior-posterior rim deficiency, only 8 underwent successful immediate transcatheter closure. Four cases failed to be closed. Major complications occurred in 6 patients, including 4 device embolizations, 1 pericardial effusion and 1 complete atrioventricular block that resolved after surgical removal of the device. During a median follow up of 54±13 months, a residual right-to-left shunt was documented in 2 more cases, requiring surgery in one case because of cyanosis. Transcatheter closure was successfully performed in the rest of the 223 patients, including in the 32 cases with deficient rims other than inferior-posterior.
Transcatheter closure of ASDs with inferior-posterior rim deficiency cannot be recommended.
关于经导管封堵继发孔型房间隔缺损（ASD）合并下后缘缺失的报道较少，且对其适应证和局限性缺乏恰当的认识。我们旨在评估经导管封堵边缘缺损型ASD的安全性和可行性，尤其关注合并下后缘缺损的病例。
2008年1月至2013年1月，241例患者接受了经导管ASD封堵术，其中50例（20.7%）存在除上前缘外的边缘缺损。18例患者（12例女性）存在下后缘缺损。他们的中位年龄为8（1.4 - 85）岁，中位体重为24[9 - 97]kg。所有病例均在经食管超声心动图（TEE）引导下对儿童进行封堵，在心脏内超声心动图（ICE）引导下对成人进行封堵。
18例合并下后缘缺损的患者中，仅8例成功进行了即刻经导管封堵。4例封堵失败。6例患者发生了主要并发症，包括4例封堵器栓塞、1例心包积液和1例完全性房室传导阻滞，后者在手术取出封堵器后恢复。在中位随访54±13个月期间，另外2例患者出现残余右向左分流，其中1例因发绀需要手术治疗。其余223例患者，包括32例除下后缘外边缘缺损的患者，经导管封堵均成功。
不推荐对合并下后缘缺损的ASD进行经导管封堵。
