Ghaderian Mehdi, Sabri Mohammad Reza, Ahmadi Ali Reza, Dehghan Bahar, Mahdavi Chehre, Ataei Zakie Zahra
Associate Professor, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Professor, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
ARYA Atheroscler. 2019 Jan;15(1):27-32. doi: 10.22122/arya.v15i1.1805.
Atrial septal defect (ASD) accounts for about 10% of congenital heart diseases (CHDs). Self-closure of these defects in patients with defects less than 8 mm has been reported in several studies. In children, transcatheter closure of the ASD is suggested for asymptomatic patients older than two years and with weight > 15 kg. The purpose of this study was to show that transcatheter closure of ASD in small children with body weight less than 10 kg is an effective and safe method.
Between July 2016 and September 2018, 35 children with body weight less than 10 kg underwent percutaneous closure of ASD using amplatzer. All patients had minimum defect size of 6 mm, pulmonary blood flow (Qp) to systemic blood flow (Qs) ratio above 1.5, right atrial and ventricular dilation, symptoms of delayed growth, and recurrent respiratory infections in their evaluation and had acceptable rims for intervention. Follow-up evaluations were done 1 day, 1 week, 1 month, 6 months, and yearly after discharge with transthoracic echocardiography (TTE) and electrocardiography (ECG).
The mean age of patients at procedure was 12.06 ± 4.47 months (range: 6 to 14 months), mean weight was 8.32 ± 0.72 kg (range: 7.5 to 9.8 kg). The mean defect size was 10.00 ± 2.32 mm (range: 6-13 mm). The mean device size used was 10.57 ± 2.57 mm (range: 7.5 to 15 mm). Mean duration of follow-up was 16.66 ± 6.93 months (range: 1-29 months). Respiratory rate, heart rate, pulmonary stenosis (PS), and Qp to Qs ratio had significant difference before and after procedure during the follow up (P < 0.001).
Transcatheter closure of ASD with amplatzer in symptomatic small children and infants is a safe and effective treatment associated with excellent success, but long-term follow-up in a large number of patients would be warranted.
房间隔缺损（ASD）约占先天性心脏病（CHD）的10%。多项研究报道了缺损小于8mm的患者中这些缺损的自然闭合情况。对于年龄大于2岁且体重>15kg的无症状儿童，建议行经导管房间隔缺损封堵术。本研究的目的是表明，对体重小于10kg的小儿行经导管房间隔缺损封堵术是一种有效且安全的方法。
2016年7月至2018年9月期间，35名体重小于10kg的儿童使用Amplatzer封堵器行经皮房间隔缺损封堵术。所有患者在评估时最小缺损尺寸为6mm，肺血流量（Qp）与体循环血流量（Qs）之比大于1.5，右心房和心室扩大，生长发育迟缓症状，反复呼吸道感染，且有可接受的介入边缘。出院后1天、1周、1个月、6个月及每年进行随访评估，采用经胸超声心动图（TTE）和心电图（ECG）检查。
手术时患者的平均年龄为12.06±4.47个月（范围：6至14个月），平均体重为8.32±0.72kg（范围：7.5至9.8kg）。平均缺损尺寸为10.00±2.32mm（范围：6 - 13mm）。使用的封堵器平均尺寸为10.57±2.57mm（范围：7.5至15mm）。平均随访时间为16.66±6.93个月（范围：1至29个月）。随访期间，呼吸频率、心率、肺动脉狭窄（PS）以及Qp与Qs之比在手术前后有显著差异（P < 0.001）。
对于有症状的小儿和婴儿，使用Amplatzer封堵器行经导管房间隔缺损封堵术是一种安全有效的治疗方法，成功率高，但需要对大量患者进行长期随访。
