Abdulwahab Hussein, Husain Mohammed Rassul, Khalid Khalid A
Department of Cardiology, Ibn Albitar Center for Cardiac Surgery, Baghdad, Iraq.
Department of Pediatric Cardiology, Collage of Medicine, University of Basra, Basra, Iraq.
J Interv Cardiol. 2022 Apr 4;2022:2764296. doi: 10.1155/2022/2764296. eCollection 2022.
Surgical closure of a large secundum atrial septal defect (ASD) with an absent superior or inferior rim is the standard method of management, but transcatheter closure of such a defect is possible and feasible.
To evaluate the feasibility, effectiveness, and safety of transcatheter closure of large secundum ASD with an absent superior or inferior rim through implantation of a cheatham platinum (CP) stent at the entrance of the superior vena cava (SVC) or inferior vena cava (IVC) into the right atrium (RA) to create a suitable rim for subsequent complete closure of the defect using a septal occluder. . This case series was carried out at Ibn Al-Bitar Center for Cardiac Surgery, Baghdad, Iraq from 2014 to 2019, five patients underwent such transcatheter approach for closure of large secundum ASD with the absent superior or inferior rim by implantation of CP stent at the entrance of vena cave into the RA.
The ages and weights of patients who were enrolled in this study ranged from 9-31 years (15.2 ± 9 years) and 31.5-62 kg (42.6 ± 12 kg). Three patients had absent superior rims, and the other two had absent inferior rims. The / was ranged from 1.9-3.2 (2.78 ± 0.29), and the mean pulmonary arterial pressure ranged from 22-29 mmHg (25.4 ± 3 mmHg). The defects with an absent superior rim were closed successfully by implantation of CP stents of 45, 45, and 39 mm to create a rim which supported the left atrial disc of 30, 38, and 32 mm atrial septal occluder (ASO), respectively, while large secundum ASD with an absent inferior rim could be effectively closed by implantation of two overlapping bare CP stents of 45 mm to create an IVC rim that supported 34 mm and 30 mm atrial septal occluder. . Transcatheter closure of large secundum ASD with absent superior or inferior rim is possible and effective by implantation of covered and bare CP stents at the entrance of SVC and IVC, respectively. Although these procedures are relatively difficult and challenging, especially in the closure of large defects associated with absent inferior rim, they carry a high risk of stent migration (8 zig, 45 mm), so we recommend using a CP-stent (10 zig, 60 mm).
手术闭合继发孔型房间隔缺损（ASD）且上缘或下缘缺失是标准的治疗方法，但经导管闭合此类缺损是可行的。
通过在上腔静脉（SVC）或下腔静脉（IVC）进入右心房（RA）的入口处植入Cheatham铂金（CP）支架，为后续使用房间隔封堵器完全闭合缺损创造合适的边缘，以评估经导管闭合继发孔型大ASD且上缘或下缘缺失的可行性、有效性和安全性。本病例系列于2014年至2019年在伊拉克巴格达的伊本·比特尔心脏外科中心开展，5例患者接受了这种经导管方法，通过在腔静脉进入RA的入口处植入CP支架来闭合继发孔型大ASD且上缘或下缘缺失。
纳入本研究的患者年龄为9至31岁（15.2±9岁），体重为31.5至62千克（42.6±12千克）。3例患者上缘缺失，另外2例患者下缘缺失。缺损大小范围为1.9至3.2（2.78±0.29），平均肺动脉压范围为22至29毫米汞柱（25.4±3毫米汞柱）。上缘缺失的缺损通过分别植入45毫米、45毫米和39毫米的CP支架成功闭合，以形成分别支撑30毫米、38毫米和32毫米房间隔封堵器（ASO）左心房盘的边缘，而下缘缺失的继发孔型大ASD通过植入两个重叠的45毫米裸CP支架有效闭合，以形成支撑34毫米和30毫米房间隔封堵器的IVC边缘。通过分别在SVC和IVC入口处植入带膜和裸CP支架，经导管闭合继发孔型大ASD且上缘或下缘缺失是可行且有效的。尽管这些操作相对困难且具有挑战性，尤其是在闭合与下缘缺失相关的大缺损时，它们存在较高的支架迁移风险（8之字形，45毫米），因此我们建议使用CP支架（10之字形，60毫米）。
