Smerdziński Sebastian, Gałeczka Michał, Tyc Filip, Knop Mateusz, Białkowski Jacek, Fiszer Roland
Department of Congenital Heart Defects and Pediatric Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.
Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Kardiol Pol. 2023;81(3):259-264. doi: 10.33963/KP.a2023.0001. Epub 2023 Jan 3.
Transcatheter closure of atrial septal defect (ASD) has become the treatment of choice for most patients. About 5% of them suffer from transient headache episodes (THE) after the procedure, whose etiology is unclear.
To evaluate risk factors for THE occurrence after transcatheter closure of ASD in the pediatric population.
Eight hundred and forty patients, after transcatheter ASD closure with nitinol devices, from a single center, were included in retrospective analysis. THE was defined as occurring up to 24 hours after the procedure. A logistic regression model including age, weight, ASD diameter, device size, presence of nitinol coating on the device, fluoroscopy time, application of balloon calibration, device oversizing, and residual shunt after 24 hours was created to evaluate risk factors for THE occurrence.
There were 40 patients with THE (4.8%), 70% female and 30% male. The median age was 13 (7.35-16) years. In patients with headache, balloon calibration (BC) was performed more frequently (82.5% vs. 43.3%; P <0.001). The balloon waist median (interquartile range [IQR]), 19 (16-22) mm vs. 15 mm (12-18) mm (P <0.001), and device size median (IQR), 18 (13.5-22) mm vs. 14 (11-17) mm (P <0.001) were larger, and residual shunt after 24 hours (12.5% vs. 4.9%; P = 0.03) and a year (7.5 vs. 1.0%; P <0.001) were more frequent. ASD size and the prevalence of double/multiple ASD were similar in both groups. Age, BC application, no nickel release protection, duration of fluoroscopy, and device oversizing were predictors of THE (P <0.001).
BC during percutaneous ASD closure and the lack of a protective layer against nickel release on the device are risk factors for headache occurrence in the early postprocedural period.
经导管封堵房间隔缺损（ASD）已成为大多数患者的首选治疗方法。约5%的患者在术后会出现短暂性头痛发作（THE），其病因尚不清楚。
评估儿科人群经导管封堵ASD后发生THE的危险因素。
对来自单一中心的840例使用镍钛合金装置经导管封堵ASD的患者进行回顾性分析。THE定义为术后24小时内发生。建立了一个逻辑回归模型，纳入年龄、体重、ASD直径、装置尺寸、装置上镍钛合金涂层的存在情况、透视时间、球囊校准的应用、装置过大以及24小时后的残余分流，以评估发生THE的危险因素。
有40例患者发生THE（4.8%），其中女性占70%，男性占30%。中位年龄为13（7.35 - 16）岁。头痛患者中，球囊校准（BC）的实施更为频繁（82.5%对43.3%；P <0.001）。球囊腰部中位数（四分位间距[IQR]），19（16 - 22）mm对15 mm（12 - 18）mm（P <0.001），以及装置尺寸中位数（IQR），18（13.5 - 22）mm对14（11 - 17）mm（P <0.001）更大，24小时后（12.5%对4.9%；P = 0.03）和一年后（7.5对1.0%；P <0.001）的残余分流更常见。两组的ASD大小和双/多发性ASD的患病率相似。年龄、BC应用、无镍释放保护、透视持续时间和装置过大是THE的预测因素（P <0.001）。
经皮ASD封堵术中的BC以及装置上缺乏抗镍释放的保护层是术后早期发生头痛的危险因素。
