Zhou Zeming, Gu Yuanrui, Zheng Hong, Song Huijun, Li Shiguo, Yan Chaowu, Xu Zhongying
Department of Structural Heart Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
J Thorac Dis. 2022 Jul;14(7):2461-2471. doi: 10.21037/jtd-21-1782.
Transcatheter closure of inferior sinus venosus defect (ISVD) is still contraindication. To explore whether transcatheter closure with patent ductus arteriosus (PDA) occluders is possible for ISVD.
From June 2014 to March 2021, 12 patients were recruited diagnosed as <25 mm ISVD. The three-dimensional printing (3DP) heart model was produced based on multi-slice computed tomography (MSCT) scans. Preoperative closure simulation was planned on the personalized 3D model for each patient. Follow-up including electrocardiography (ECG), transthoracic echocardiography (TTE), and X-ray was traced.
3DP models of 12 patients were successfully printed. Twelve patients had been diagnosed with <25 mm ISVD and 4 of them had another secundum atrial septal defect (ASD). All patients were produced interventional therapy successfully. PDA occluder was implanted to closed ISVD, and ASD was closed using ASD occluder simultaneously. The average diameter of ISVD measured by TTE was (12.67±3.80), and the average diameter of sagittal axes and longitudinal axes measured by the 3D-printed model was (17.08±3.20) and (18.42±4.62) mm, respectively. The average size of PDA (diameter of pulmonary artery side) was (28.17±3.35) mm. Compared with the preoperative, the X-ray cardiothoracic ratio (0.51±0.04 0.47±0.06, P=0.007) and the right ventricle anterior-posterior diameter (31.17±5.65 24.58±3.75 mm, P<0.001) of postoperative was significantly decreased. During the average (47.75±27.52) months follow-up, it has achieved satisfying results, and there were no severe adverse events such as device transposition, death, and pericardial tamponade occurred.
Assisting by 3D heart model, transcatheter closure of ISVD with PDA occluder had an excellent outcome. This method provides a new considerable treatment strategy for ISVD.
经导管闭合下腔静脉窦型缺损（ISVD）仍属禁忌。探讨使用动脉导管未闭（PDA）封堵器经导管闭合ISVD是否可行。
2014年6月至2021年3月，招募12例诊断为ISVD且缺损直径<25 mm的患者。基于多层螺旋CT（MSCT）扫描制作三维打印（3DP）心脏模型。为每位患者在个性化3D模型上进行术前封堵模拟。进行包括心电图（ECG）、经胸超声心动图（TTE）及X线检查的随访。
成功打印12例患者的3DP模型。12例患者诊断为ISVD且缺损直径<25 mm，其中4例合并继发孔型房间隔缺损（ASD）。所有患者均成功接受介入治疗。植入PDA封堵器闭合ISVD，同时使用ASD封堵器闭合ASD。TTE测量的ISVD平均直径为（12.67±3.80）mm，3D打印模型测量的矢状轴和纵轴平均直径分别为（17.08±3.20）mm和（18.42±4.62）mm。PDA（肺动脉侧直径）平均尺寸为（28.17±3.35）mm。术后X线心胸比率（0.51±0.04比0.47±0.06，P = 0.007）及右心室前后径（31.17±5.65比24.58±3.75 mm，P<0.001）较术前显著减小。在平均（47.75±27.52）个月的随访期间，取得了满意的结果，未发生封堵器移位、死亡及心包填塞等严重不良事件。
在3D心脏模型辅助下，使用PDA封堵器经导管闭合ISVD效果良好。该方法为ISVD提供了一种新的、值得考虑的治疗策略。
