Cardiology Department, Centro Hospitalar e universitário de Coimbra - Hospital Geral, Quinta dos Vales - São Martinho do Bispo, 3043-853, Coimbra, Portugal.
ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Int J Cardiovasc Imaging. 2021 Aug;37(8):2359-2368. doi: 10.1007/s10554-021-02212-4. Epub 2021 Mar 14.
There is conflicting evidence regarding the significance of iatrogenic atrial septal defects (iASDs) after transseptal puncture during percutaneous cardiac interventions. To study the clinical outcome of iASD after percutaneous left atrial appendage occlusion (LAAo). Single-center, retrospective study of 70 consecutive patients who underwent percutaneous LAAo between May 2010 and August 2017, and subsequent transesophageal echocardiography (TEE) at 1 month. The sample population was divided into two groups: A (with iASD, 22 (37%) patients) and B (no iASD, 44 (63%) patients). Procedures were guided either by TEE (36 patients (54%)) or intracardiac echocardiography (ICE) from the left atrium (30 patients (46%)). The primary end point was presence of iASD at 1 month, and secondary end points included mortality, hospital admission due to heart failure (HF), and right atrium (RA) size during follow-up. 70 patients were included in this study and the prevalence of iASD at 1 month was 37%. The use of ICE was associated with iASD (adjusted odds ratio, 3.79; 95% CI 1.27-11.34). The presence of iASD was not associated with adverse events (mortality, 15.4% vs 20.5%; P = 0.60; HF hospitalizations, 7.7% vs 13.6%, P = 0.45; and RA area, 24.8 ± 7.0 cm vs 22.2 ± 6.8 cm, P = 0.192). At 1-month follow-up after LAAo, iASD was present in one third of patients, but was not associated with clinical outcomes. The use of ICE was associated with a higher risk of short-term iASD.
经皮左心耳封堵术（LAAo）后，经房间隔穿刺引起的医源性房间隔缺损（iASD）的意义存在争议。研究经皮左心耳封堵术（LAAo）后 iASD 的临床结果。这是一项单中心回顾性研究，纳入了 2010 年 5 月至 2017 年 8 月期间接受经皮 LAAo 治疗的 70 例连续患者，随后在 1 个月时进行经食管超声心动图（TEE）检查。将样本人群分为两组：A 组（存在 iASD，22 例（37%）患者）和 B 组（无 iASD，44 例（63%）患者）。该程序由 TEE（36 例（54%））或左心房内的心脏超声（ICE）（30 例（46%））指导。主要终点是 1 个月时 iASD 的存在，次要终点包括死亡率、因心力衰竭（HF）住院以及随访期间右心房（RA）的大小。这项研究共纳入了 70 例患者，1 个月时 iASD 的患病率为 37%。ICE 的使用与 iASD 相关（调整后的优势比，3.79；95%置信区间 1.27-11.34）。存在 iASD 与不良事件无关（死亡率，15.4%比 20.5%；P=0.60；HF 住院率，7.7%比 13.6%，P=0.45；RA 面积，24.8±7.0cm 比 22.2±6.8cm，P=0.192）。LAAo 后 1 个月随访时，三分之一的患者存在 iASD，但与临床结果无关。ICE 的使用与短期 iASD 的风险增加相关。
