5th Year MBBS Student, Ziauddin Medical University, Karachi, Pakistan.
Tabba Heart Institute, Karachi, Pakistan.
J Pak Med Assoc. 2022 Feb;72(2):385-389. doi: 10.47391/JPMA.106.
To assess immediate outcome and complications of Amplatzer septal occluder percutaneous device for closure of secundum atrial septal defect in adults, and to determine regression in right ventricular size, reduced pulmonary arterial systolic pressure and incidence of device embolization at follow-up.
The single-cohort, ambi-directional, observational study was conducted at the Tabba Heart Institute, Karachi, from January 2013 to July 2018, and comprised patients admitted consecutively for percutaneous atrial septal defect closure. Pre-closure trans-oesophageal echocardiogram was performed in all cases to ensure adequacy of defect margins necessary for device stability. Immediate procedure success and complications were determined by trans-oesophageal echocardiogram, while transthoracic echo was done on follow-up. Data was analysed using SPSS 21.
Of the 64 patients, 41(71.9%) were females. The overall mean age was 36.6±14 years. Median size of atrial septal defect was 21mm (interquartile range: 17-26mm). Immediate success was observed in 59(92.2%) patients, and there were 5(8%) acute device embolization events. Small residual atrial septal defect was found in 4(6.3%) cases. On 20-month follow-up, 54(84.4%) patients showed improved symptoms. Repeat transthoracic echo was performed in 39(60.1%) cases, and there were no late embolic events or residual atrial septal defect. Right ventricular size normalized in 34(89.5%) cases, mean pulmonary arterial systolic pressure reduced significantly compared to pre-closure measurement (p<0.001).
Percutaneous atrial septal defect closure was found to be safe and effective in adults with secundum atrial septal defect. Timely closure resulted in improved symptoms, right ventricular remodelling and reduced pulmonary arterial systolic pressure at intermediate-term follow-up.
评估 Amplatzer 隔瓣缺损封堵器经皮装置在成人继发房间隔缺损中的即刻结果和并发症，并确定右心室大小的回归、肺动脉收缩压降低和随访期间器械栓塞的发生率。
这项单队列、双向、观察性研究于 2013 年 1 月至 2018 年 7 月在卡拉奇的塔巴心脏研究所进行，纳入了连续收治的经皮房间隔缺损封堵患者。所有病例均行术前经食管超声心动图检查，以确保设备稳定性所需的缺陷边缘充足。即刻手术成功率和并发症通过经食管超声心动图确定，而在随访时进行经胸超声心动图检查。数据采用 SPSS 21 进行分析。
在 64 例患者中，41 例（71.9%）为女性。患者的总体平均年龄为 36.6±14 岁。房间隔缺损的中位数大小为 21mm（四分位距：17-26mm）。59 例（92.2%）患者即刻成功，5 例（8%）发生急性器械栓塞事件。4 例（6.3%）发现小残余房间隔缺损。20 个月随访时，54 例（84.4%）患者症状改善。39 例（60.1%）患者重复进行经胸超声心动图检查，无晚期栓塞事件或残余房间隔缺损。34 例（89.5%）患者的右心室大小正常化，与术前测量相比，平均肺动脉收缩压显著降低（p<0.001）。
经皮房间隔缺损封堵术在成人继发房间隔缺损中是安全有效的。及时封堵可在中期随访时改善症状、右心室重塑和降低肺动脉收缩压。
