Seol Jae-Hee, Kim Ah-Young, Jung Se-Yong, Choi Jae-Young, Park Yeon-Jae, Jung Jo-Won
Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26493, Korea.
J Clin Med. 2022 Apr 24;11(9):2394. doi: 10.3390/jcm11092394.
We aimed to determine the feasibility, efficacy, success, and safety of intracardiac echocardiography (ICE) in transcatheter multiple atrial septal defect (ASD) closure. Of 185 patients with multiple ASDs who underwent transcatheter closure, 140 (76%) patients who weighed <30kg with a narrow distance between defects or in whom single device closure was anticipated were guided by ICE and 45 patients were guided by three-dimensional (3D) transesophageal echocardiography (TEE) with or without ICE. Patients in the ICE group were relatively younger and weighed less than those in the 3D TEE group (p < 0.0001). The ratio of the distance between defects >7 mm was high, and more cases required ≥2 devices in the 3D TEE group than those in the ICE group (p < 0.0001). All patients in the 3D TEE group and seven patients (5%) in the ICE group were operated on under general anesthesia (p < 0.0001). The fluoroscopic time was shorter in the ICE group (13.98 ± 6.24 min vs. 24.86 ± 16.47 min, p = 0.0005). No difference in the complete closure rate and complications was observed. ICE-guided transcatheter and 3D TEE were feasible, safe, and effective in successful multiple ASD device closures, especially for young children and patients at high risk under general anesthesia.
我们旨在确定心腔内超声心动图（ICE）在经导管封堵多发性房间隔缺损（ASD）中的可行性、有效性、成功率和安全性。在185例行经导管封堵术的多发性ASD患者中，140例（76%）体重<30kg、缺损间距窄或预计采用单一装置封堵的患者接受了ICE引导，45例患者接受了三维（3D）经食管超声心动图（TEE）引导，其中部分患者同时使用了ICE。ICE组患者相对更年轻，体重也低于3D TEE组（p<0.0001）。3D TEE组中缺损间距>7mm的比例更高，需要≥2个装置的病例比ICE组更多（p<0.0001）。3D TEE组所有患者及ICE组7例（5%）患者在全身麻醉下进行手术（p<0.0001）。ICE组的透视时间更短（13.98±6.24分钟 vs. 24.86±16.47分钟，p = 0.0005）。完全封堵率和并发症方面未观察到差异。ICE引导下的经导管封堵术和3D TEE在成功进行多发性ASD装置封堵方面是可行、安全且有效的，尤其适用于幼儿和全身麻醉下的高危患者。
