Świątkiewicz Iwona, Bednarczyk Łukasz, Kasprzak Michał, Laskowska Ewa, Woźnicki Marek
Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland.
Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA 92037, USA.
J Clin Med. 2022 Feb 13;11(4):973. doi: 10.3390/jcm11040973.
Concomitant systemic essential hypertension (HTN) in adults with a secundum atrial septal defect (ASD) can unfavorably affect the hemodynamics and transcatheter ASD closure (ASDC) effects. This study aims to assess the effectiveness and safety of ASDC in adults with HTN in real-world clinical practice. Right ventricular (RV) reverse remodeling (RVR) and the lack of a left-to-right interatrial residual shunt (NoRS) in echocardiography 24 h and 6 months (6 M) post-ASDC, and ASDC-related complications within 6 M were evaluated in 184 adults: 79 with HTN (HTN+) and 105 without HTN (HTN-). Compared to HTN-, HTN+ patients were older and had a greater RV size and the prevalence of atrial arrhythmias, chronic heart failure, nonobstructive coronary artery disease, diabetes, hyperlipidemia, and left ventricular diastolic dysfunction. ASDC was successful and resulted in RVR, NoRS, and a lack of ASDC-related complications in the majority of HTN+ patients both at 24 h and 6 M. HTN+ and HTN- did not differ in ASD size, a successful implantation rate (98.7% vs. 99%), RVR 24 h (46.8% vs. 46.7%) and 6 M (59.4% vs. 67.9%) post-ASDC, NoRS 24 h (79% vs. 81.5%) and 6 M (76.6% vs. 86.9%) post-ASDC, and the composite of RVR and NoRS at 6 M (43.8% vs. 57.1%). Most ASDC-related complications in HTN+ occurred within 24 h and were minor; however, major complications such as device embolization within 24 h and mitral regurgitation within 6 M were observed. No differences between HTN+ and HTN- were observed in the total (12.7% vs. 9.5%) and major (5.1% vs. 4.8%) complications. Transcatheter ASDC is effective and safe in adults with secundum ASD and concomitant HTN in real-world clinical practice; however, proper preprocedural management and regular long-term follow-up post-ASDC are required.
继发孔型房间隔缺损（ASD）成人患者合并系统性原发性高血压（HTN）会对血流动力学及经导管房间隔缺损封堵术（ASDC）效果产生不利影响。本研究旨在评估在真实世界临床实践中ASDC治疗合并HTN的成人患者的有效性和安全性。对184例成人患者进行评估，其中79例合并HTN（HTN+组），105例不合并HTN（HTN-组），观察ASDC术后24小时及6个月（6M）时超声心动图显示的右心室（RV）逆向重构（RVR）及房水平无残余分流（NoRS）情况，以及6M内ASDC相关并发症。与HTN-组相比，HTN+组患者年龄更大，RV尺寸更大，房性心律失常、慢性心力衰竭、非梗阻性冠状动脉疾病、糖尿病、高脂血症及左心室舒张功能障碍的患病率更高。大多数HTN+组患者在24小时及6M时ASDC均成功，且出现RVR、NoRS，未发生ASDC相关并发症。HTN+组与HTN-组在ASD大小、成功植入率（98.7%对99%）、ASDC术后24小时（46.8%对46.7%）及6M（59.4%对67.9%）时的RVR、ASDC术后24小时（79%对81.5%）及6M（76.6%对86.9%）时的NoRS，以及6M时RVR和NoRS的复合情况（43.8%对57.1%）方面无差异。HTN+组大多数ASDC相关并发症发生在24小时内且为轻微并发症；然而，观察到24小时内发生器械栓塞及6M内发生二尖瓣反流等严重并发症。HTN+组与HTN-组在总并发症（12.7%对9.5%）及严重并发症（5.1%对4.8%）方面无差异。在真实世界临床实践中，经导管ASDC治疗继发孔型ASD合并HTN的成人患者是有效且安全的；然而，需要进行适当的术前管理及ASDC术后定期长期随访。
