Haddad Raymond N, Kaddoura Rachid, Kasem Mohamed, Alsoufi Mahmoud
Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
Front Cardiovasc Med. 2023 May 22;10:1155142. doi: 10.3389/fcvm.2023.1155142. eCollection 2023.
Transcatheter closure of atrial septal defects (ASDs) is well-established. However, this procedure can be challenging, requiring multiple attempts and advanced implantation maneuvers.
From July 2019 to July 2022, patients to whom the fast atrial sheath traction (FAST) technique was applied for ASD device closure were prospectively followed up. The device was rapidly unsheathed in the middle of the left atrium (LA) to let it clamp the ASD from both sides simultaneously. This novel technique was directly applied in patients with absent aortic rims and/or ASD size-to-body weight ratio higher than 0.9 or after failed attempts of standard implantation.
Seventeen patients (64.7% males) were involved with a median age of 9.8 years [interquartile range (IQR), 7.6-15.1] and a median weight of 34 kg (IQR, 22-44). The median ASD size on ultrasound was 19 mm (IQR, 16-22). Five (29.4%) patients had absent aortic rims, and three (17.6%) patients had an ASD size-to-body weight ratio higher than 0.9. The median device size was 22 mm (IQR, 17-24). The median difference between device size and ASD two-dimensional static diameter was 3 mm (IQR, 1-3). All interventions were straightforward without any complications using three different occluder devices. One device was removed before release and upsized to the next size. The median fluoroscopy time was 4.1 min (IQR, 3.6-4.6). All patients were discharged the next postoperative day. On a median follow-up of 13 months (IQR, 8-13), no complications were detected. All patients achieved full clinical recovery with complete shunt closure.
We present a new implantation technique to efficiently close simple and complex ASDs. The FAST technique can be of benefit in overcoming left disc malalignment to the septum in defects with absent aortic rims and in avoiding complex implantation maneuvers and the risks of injuring the pulmonary veins.
经导管闭合房间隔缺损（ASD）已得到广泛应用。然而，该操作可能具有挑战性，需要多次尝试和采用先进的植入技巧。
对2019年7月至2022年7月期间采用快速心房鞘管牵引（FAST）技术进行ASD封堵器闭合的患者进行前瞻性随访。封堵器在左心房（LA）中部快速出鞘，使其同时从两侧夹住ASD。这项新技术直接应用于无主动脉边缘、和/或ASD大小与体重之比高于0.9的患者，或在标准植入尝试失败后使用。
共纳入17例患者（男性占64.7%），中位年龄为9.8岁[四分位间距（IQR），7.6 - 15.1]，中位体重为34 kg（IQR，22 - 44）。超声测量的ASD中位大小为19 mm（IQR，16 - 22）。5例（29.4%）患者无主动脉边缘，3例（17.6%）患者的ASD大小与体重之比高于0.9。封堵器中位大小为22 mm（IQR，17 - 24）。封堵器大小与ASD二维静态直径的中位差值为3 mm（IQR，1 - 3）。使用三种不同的封堵器装置，所有干预操作均顺利，无任何并发症。一个封堵器在释放前被取出并换为更大一号的。中位透视时间为4.1分钟（IQR，3.6 - 4.6）。所有患者术后次日出院。中位随访13个月（IQR，8 - 13）时，未发现并发症。所有患者均实现完全临床康复，分流完全闭合。
我们提出了一种新的植入技术，可有效闭合简单和复杂的ASD。FAST技术有助于克服无主动脉边缘缺损中左盘与隔膜的不对齐，避免复杂的植入操作以及损伤肺静脉的风险。
