Division of Pediatric Cardiology, Duke University, Durham, USA.
Curr Cardiol Rep. 2023 Sep;25(9):1083-1093. doi: 10.1007/s11886-023-01925-3. Epub 2023 Jul 31.
The goal of this paper is to review currently available devices for closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs).
Favorable results from the ASSURED trial resulted in FDA approval for the most recently developed device for transcatheter ASD closure in the United States. Further studies are required to assist in the development or approval of safe devices for transcatheter perimembranous VSD closure in pediatric patients. Device closure is the less invasive and preferred management option for many ASDs, with multiple studies demonstrating lower complication rates, shorter hospital stays, and lower mortality than surgical repair. Complex ASDs that make device closure more difficult include large defects, rim deficiencies, fenestrated defects, multiple defects, and the presence of pulmonary arterial hypertension. Device closure has also become an accepted alternative to surgery for some types of ventricular septal defects VSDs, though challenges and limitations remain. Future innovations including novel devices and techniques are needed to further expand on the types of defects that can be safely closed via transcatheter approach.
本文旨在回顾目前可用于房间隔缺损(ASD)和室间隔缺损(VSD)封堵的装置。
ASSURED 试验的良好结果促使美国食品和药物管理局(FDA)批准了最近开发的用于经导管 ASD 封堵的装置。需要进一步的研究来协助开发或批准用于经导管膜周部 VSD 封堵的安全装置,因为对于儿科患者来说,经导管封堵是一种侵入性更小、更受推荐的治疗选择。许多研究表明,与手术修复相比,经导管封堵 ASD 的并发症发生率更低、住院时间更短、死亡率更低,因此成为了许多 ASD 的首选治疗方法。使经导管封堵更具挑战性的复杂 ASD 包括大的缺损、边缘缺陷、多孔性缺损、多个缺损和肺动脉高压。经导管封堵也已成为某些类型 VSD 手术的替代方法,但仍存在挑战和局限性。需要包括新型装置和技术在内的未来创新,进一步扩大可通过经导管方法安全封堵的缺陷类型。