Singhi Anil K, Mahapatra Soumya K, Kumar Dilip, Dey Somnath, Mishra Amiya, De Arnab
Pediatric Cardiology, Medica Super Specialty Hospital, Kolkata, IND.
Cardiology, Medica Super Specialty Hospital, Kolkata, IND.
Cureus. 2022 Feb 22;14(2):e22480. doi: 10.7759/cureus.22480. eCollection 2022 Feb.
Objective Transcatheter atrial septal defect (ASD) device closure in the older population presents a greater challenge due to the long-standing effect of atrial left-to-right shunt. This study analyzes the challenges encountered in transcatheter ASD device closure in older patients in their fifth decade and beyond. Methods Adults aged 40 years and above with significant secundum ASD who underwent transcatheter ASD device closure between June 2015 and April 2021 were analyzed. Challenges were classified as major and minor challenges based on their impact on the alteration of the treatment protocol. Patients were categorized into three subgroups according to age. Group 1 consisted of patients aged 40-49 years (n = 13), Group 2 consisted of patients aged 50-59 years (n = 16), and Group 3 consisted of patients aged 60 years and above (n = 8). Results A total of 37 patients were analyzed. The challenges encountered were arrhythmia, pulmonary hypertension, left ventricular diastolic dysfunction, bleeding, stroke, coronary artery disease (CAD), hypertension, and airway disease. Thirteen percent of challenges were seen in pre-procedure time, whereas 79% of challenges during the procedure and 8% of challenges during post-procedure were seen. Thirty-five patients (94.6%) underwent transcatheter ASD device closure. Two patients (5.4%) did not undergo transcatheter ASD device closure due to severe diastolic dysfunction and associated CAD, respectively. Eleven major challenges were encountered in 10 patients in which one patient had a dual challenge of bleeding and arrhythmia. Thirteen patients (35.1%) had smooth procedures without any challenges encountered. Twenty-seven minor challenges were encountered in 20 patients with some patients having an overlap of multiple major and minor challenges. The patients were doing well at the mean follow-up of 28 months. Conclusions Transcatheter ASD device closure in older patients who are 40 years and above is safe and effective. Such high-risk patients are prone to various challenges that can be effectively managed if optimally monitored on the basis of a proper understanding of the altered physiology and anticipation of the deviated course at various stages of the procedure.
目的 由于心房左向右分流的长期影响，老年人群经导管房间隔缺损（ASD）封堵术面临更大挑战。本研究分析了50岁及以上老年患者经导管ASD封堵术中遇到的挑战。方法 分析2015年6月至2021年4月期间接受经导管ASD封堵术的40岁及以上患有显著继发孔型ASD的成人。根据对治疗方案改变的影响，将挑战分为主要挑战和次要挑战。患者按年龄分为三个亚组。第1组由40 - 49岁的患者组成（n = 13），第2组由50 - 59岁的患者组成（n = 16），第3组由60岁及以上的患者组成（n = 8）。结果 共分析了37例患者。遇到的挑战包括心律失常、肺动脉高压、左心室舒张功能障碍、出血、中风、冠状动脉疾病（CAD）、高血压和气道疾病。13%的挑战出现在术前，而79%的挑战出现在术中，8%的挑战出现在术后。35例患者（94.6%）接受了经导管ASD封堵术。2例患者（5.4%）分别因严重舒张功能障碍和相关CAD未接受经导管ASD封堵术。10例患者遇到11项主要挑战，其中1例患者同时面临出血和心律失常双重挑战。13例患者（35.1%）手术顺利，未遇到任何挑战。20例患者遇到27项次要挑战，部分患者同时存在多项主要和次要挑战。患者在平均28个月的随访中情况良好。结论 40岁及以上老年患者经导管ASD封堵术安全有效。此类高危患者容易面临各种挑战，如果在正确理解生理改变并预期手术各阶段偏离过程的基础上进行最佳监测，这些挑战是可以有效管理的。
