Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia.
Electrophysiology Unit, Department of Cardiology, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia.
Pacing Clin Electrophysiol. 2020 Nov;43(11):1252-1257. doi: 10.1111/pace.14049. Epub 2020 Sep 7.
Elderly patients with atrial septal defect (ASD) often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and ASD closure in patients with significant ASD and chronic atrial fibrillation.
We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from January 1, 2014 until December 31, 2019. All periprocedural and long-term (>1 year) outcomes were reported.
Six patients (male: 33.3%; mean age: 66.8 ± 3.3 years) were included. Mean CHADS , CHA DS -VAS , and HAS-BLED scores were 2.33 ± 0.82, 3.83 ± 0.75, and 1.83 ± 0.75. Four patients underwent simultaneous procedure, while two patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8 ± 19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack.
LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant ASD.
老年房间隔缺损（ASD）患者常伴有慢性心房颤动和左向右分流较大。本研究报告了在有明显 ASD 和慢性心房颤动的患者中进行左心耳（LAA）和 ASD 封堵的经验。
我们报告了 2014 年 1 月 1 日至 2019 年 12 月 31 日期间连续 6 例患有慢性心房颤动和明显 ASD 的老年患者进行 LAA 和带孔 ASD 封堵的情况。报告了所有围手术期和长期（>1 年）的结果。
6 例患者（男性：33.3%；平均年龄：66.8±3.3 岁）入选。平均 CHADS₂、CHA₂DS₂-VASc 和 HAS-BLED 评分分别为 2.33±0.82、3.83±0.75 和 1.83±0.75。4 例患者同时进行了手术，2 例患者分期进行了手术。所有患者均获得了手术成功。在 ASD 封堵前，LAA 封堵时无需器械栓塞即可实现完全闭塞。同期手术的患者总住院时间更短。在 32.8±19.4 个月的随访期间，两个器械均固定良好。无器械相关血栓形成或侵蚀报告。所有患者均持续处于心房颤动状态。无患者发生任何血栓栓塞性卒中或短暂性脑缺血发作。
在有明显 ASD 的老年患者中，LAA 和 ASD 封堵是可行的，且可安全地同期进行。
