Soma Yusuke, Shiraishi Yasuyuki, Kanazawa Hideaki, Fukuda Keiichi
Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan.
Eur Heart J Case Rep. 2019 Jun 1;3(2). doi: 10.1093/ehjcr/ytz044.
Atrial septal defect (ASD) and patent ductus arteriosus (PDA) are both common congenital heart diseases, but the combination of these two cardiac defects is extremely rare, and the therapeutic strategy is controversial.
We treated an adult patient with combined ASD and PDA, and safely attained a successful outcome with two-stage transcatheter closure, which is PDA closure preceding ASD closure, to prevent serious complications.
Transcatheter closure of one of the defects is now widely accepted as an alternative to surgical closure. In addition, adults with both ASD and PDA are better suited for transcatheter closure than surgical closure. One of the reasons is the difficulty to ligate the ductus arteriosus of an adult patient due to its friability and calcification. Meanwhile, simultaneous combined transcatheter closure of ASD and PDA can result in serious complications, such as thrombocytopenia and haemolysis, whose mechanism is considered to be the destruction of platelets and red blood cells by the residual shunt through implanted devices. Additionally, antiplatelet therapy that prevents device-related thrombus formation after ASD closure can possibly exacerbate thrombocytopenia and haemolysis. Therefore, the staged strategy is reasonable from the perspectives of antiplatelet therapy and haemodynamic changes.
房间隔缺损（ASD）和动脉导管未闭（PDA）均为常见的先天性心脏病，但这两种心脏缺陷合并存在极为罕见，且治疗策略存在争议。
我们治疗了一名合并ASD和PDA的成年患者，并通过两阶段经导管封堵术安全地取得了成功结果，即先封堵PDA，再封堵ASD，以预防严重并发症。
经导管封堵其中一种缺陷目前已被广泛接受为手术封堵的替代方法。此外，同时患有ASD和PDA的成年人比手术封堵更适合经导管封堵。原因之一是成年患者的动脉导管因脆弱和钙化而难以结扎。同时，ASD和PDA同时经导管联合封堵可能导致严重并发症，如血小板减少和溶血，其机制被认为是通过植入装置的残余分流对血小板和红细胞的破坏。此外，在ASD封堵后预防与装置相关血栓形成的抗血小板治疗可能会加重血小板减少和溶血。因此，从抗血小板治疗和血流动力学变化的角度来看，分阶段策略是合理的。
