Hafez Mohamed S, Abdelrahman El-Sayed Mohamed I, El Sayed Maiy H
Department of Cardiovascular Medicine, Ain Shams University Hospitals, Cairo, Egypt.
J Saudi Heart Assoc. 2022 Sep 5;34(3):148-152. doi: 10.37616/2212-5043.1313. eCollection 2022.
To evaluate the long-term outcome of patients who underwent percutaneous transcatheter closure of secundum atrial septal defects during teenage life versus adulthood.
The study included 100 patients with secundum type ASD who were treated by transcatheter closure of their defects 2-5 years before enrollment. The study population was subdivided into 2 equal groups: group 1 who underwent transcatheter closure during teenage life (13-19 years) and group 2 who underwent transcatheter closure after the age of 30 years. The two groups were compared according to resting 12 lead ECG, 24-h Holter ECG and transthoracic echocardiographic findings (Right ventricular size and functions, right atrial size, etc.).
The study population showed female predominance. The average follow up period was similar in both groups. Adult patients had more frequent right bundle branch block morphology in their resting 12 lead ECG than teenagers (69% versus 45% respectively, p < 0.01). The incidence of arrhythmias encountered in Holter ECG was also significantly higher in the adult group. Premature atrial contractions (PAC) were present in 10 patients (20%) in adult group while 3 patients (6%) had PACs in teenagers' group with p < 0.01. The mean PAC burden was also higher in the adult group (9% versus 1.3%, p < 0.001). Paroxysmal AF lasting more than 30 seconds was found in 6 patients (12%) in the adult group while 1 patient in teenagers developed AF, p < 0.01. Regarding transthoracic echocardiography, adult patients showed significantly larger RV diameter, indexed RA area, indexed LA volume and more LV diastolic dysfunction. RV systolic functions were better in the teenage group as measured by 2D echocardiography. Adult patients with higher age, bigger defect size and device size had more abnormal ECG and echocardiographic findings.
Early -catheter closure of secundum ASD during teenage life yields better right ventricular systolic function, better right ventricular size and less incidence of atrial arrhythmia.
评估青少年期与成年期行经皮导管封堵继发孔型房间隔缺损患者的长期预后。
该研究纳入100例继发孔型房间隔缺损患者，这些患者在入组前2 - 5年接受了经导管封堵缺损治疗。研究人群被分为两组，每组人数相等：第1组为青少年期（13 - 19岁）接受经导管封堵的患者，第2组为30岁以后接受经导管封堵的患者。根据静息12导联心电图、24小时动态心电图及经胸超声心动图检查结果（右心室大小和功能、右心房大小等）对两组进行比较。
研究人群以女性为主。两组的平均随访期相似。成年患者静息12导联心电图中右束支传导阻滞形态的发生率高于青少年（分别为69%和45%，p < 0.01）。动态心电图中成年组心律失常的发生率也显著更高。成年组有10例患者（20%）出现房性早搏，而青少年组有3例患者（6%）出现房性早搏，p < 0.01。成年组的平均房性早搏负荷也更高（9%对1.3%，p < 0.001）。成年组有6例患者（12%）出现持续超过30秒的阵发性房颤，而青少年组有1例患者发生房颤，p < 0.01。关于经胸超声心动图，成年患者的右心室直径、右心房指数面积、左心房指数容积显著更大，左心室舒张功能障碍更多。通过二维超声心动图测量，青少年组的右心室收缩功能更好。年龄较大、缺损和封堵器尺寸较大的成年患者心电图和超声心动图异常表现更多。
青少年期早期行经导管封堵继发孔型房间隔缺损可产生更好的右心室收缩功能、更好的右心室大小及更低的房性心律失常发生率。
