Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital (W.W.), Yonsei University College of Medicine, Seoul, Korea.
Circ Cardiovasc Imaging. 2022 Jul;15(7):e014138. doi: 10.1161/CIRCIMAGING.122.014138. Epub 2022 Jul 19.
Although the transcatheter closure of atrial septal defect was established as the treatment of choice several decades ago, the process of device neoendothelialization (NE) in humans is not well understood. We aimed to measure the extent of device NE using cardiac computed tomography angiography and analyze its risk factors.
Between January 2005 and February 2021, we retrospectively reviewed 164 devices of 112 patients on cardiac computed tomography angiography. We investigated device shape, contrast opacification within the device that differentiated device NE, and device-related thrombosis or vegetation. Risk factor analysis for major adverse cardiovascular events and incomplete NE according to the postprocedural period was performed.
Seventy patients (62.5%) were women, with a median (range) age at the time of device closure of 44.5 (0.6-79.2) years. The mean (±SD) defect size was 16.6 (±7.8) mm, and patients were followed for 35.9±33.9 months. After 6 months of device implantation, 35% of the devices (42/120) had incomplete NE. The intensity of intradevice opacification shifted from complete to partial or nonopacification over time (<0.001), and a similar pattern was observed in the shunt flow (<0.001). The bulkiness of devices also decreased in proportion to the postprocedural period (<0.001). Risk analysis revealed device diameter (hazard ratio, 1.18 [95% CI, 1.04-1.27]; <0.001) as the only significant factor of incomplete NE and major adverse events.
Incomplete NE of atrial septal defect devices was identified on cardiac computed tomography angiography in significant numbers after 6 months of the procedure. The device diameter was related to incomplete NE and major adverse events. Further prospective and multicenter studies are warranted to validate this new assessment of device NE.
尽管经导管房间隔缺损封堵术在几十年前已被确立为首选治疗方法，但人体中装置的新生内皮化（NE）过程仍不为人所熟知。我们旨在通过心脏计算机断层血管造影术来测量装置 NE 的程度，并分析其危险因素。
在 2005 年 1 月至 2021 年 2 月期间，我们回顾性地分析了 112 例患者的 164 个装置的心脏计算机断层血管造影术资料。我们研究了装置的形状、装置内区分装置 NE 的对比显影情况，以及与装置相关的血栓或赘生物。对主要不良心血管事件和根据术后时间的不完全 NE 的危险因素进行了分析。
70 例（62.5%）患者为女性，装置关闭时的中位（范围）年龄为 44.5（0.6-79.2）岁。平均（±标准差）缺损大小为 16.6（±7.8）mm，患者的中位随访时间为 35.9±33.9 个月。在装置植入后 6 个月时，35%的装置（42/120）出现不完全 NE。装置内显影的强度从完全变为部分或不显影，随时间推移呈逐渐变化趋势（<0.001），分流流量也呈类似模式（<0.001）。装置的体积也随着术后时间的延长而相应减小（<0.001）。风险分析显示，装置直径（风险比，1.18[95%可信区间，1.04-1.27]；<0.001）是不完全 NE 和主要不良事件的唯一显著因素。
在术后 6 个月时，心脏计算机断层血管造影术显示有相当数量的房间隔缺损装置出现不完全 NE。装置直径与不完全 NE 和主要不良事件相关。需要进一步进行前瞻性和多中心研究来验证这种装置 NE 的新评估方法。
