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J Invasive Cardiol. 2022 Aug;34(8):E633-E638. doi: 10.25270/jic/22.00005. Epub 2022 Jul 27.
To introduce a novel method of direct iatrogenic atrial septal defect (iASD) closure through the MitraClip steerable guide catheter (SGC).
MitraClip implantation requires transseptal puncture and the creation of an iASD. There are relatively rare instances, such as hemodynamically significant shunting or concerns for embolus, where iASD must be closed during index procedure. In these instances, it may be beneficial to not give up access to left atrium.
We retrospectively reviewed all iASD closures during MitraClip implantation at our institution from 2015 to 2020. Cases where an ASD occluder was deployed directly through SGC were included.
Eleven patients had immediate iASD closure through the SGC. Indications for using this method included concern for paradoxical embolus, large defect size and/or significant shunting. Closure device sizes ranged from 8 to 22 mm. Mean time from removal of clip delivery system to occlusion of iASD was 14.6 minutes. There were no procedural complications related to iASD closure using this method.
Closure of iASD intra-procedurally directly through transseptal guide sheath via the method described was safe and allowed for continuous left atrium access.
介绍一种通过 MitraClip 可操控导引鞘（SGC）直接进行医源性房间隔缺损（iASD）封堵的新方法。
MitraClip 植入术需要经房间隔穿刺并建立 iASD。在某些情况下，如存在血流动力学意义的分流或栓塞风险，需要在介入过程中即刻关闭 iASD。在这些情况下，保留对左心房的通路可能是有益的。
我们回顾性分析了 2015 年至 2020 年在我院行 MitraClip 植入术期间所有的 iASD 封堵病例。纳入直接通过 SGC 部署 ASD 封堵器的病例。
11 例患者通过 SGC 即刻行 iASD 封堵。采用该方法的适应证包括对矛盾性栓塞、较大缺损尺寸和/或显著分流的担忧。封堵器尺寸为 8 至 22mm。从取出夹输送系统到封堵 iASD 的平均时间为 14.6 分钟。采用该方法行 iASD 封堵未发生与操作相关的并发症。
通过本文所述的经房间隔导引导管鞘内直接封堵 iASD 的方法是安全的，并允许持续的左心房通路。
