Hribernik Ines, Bentham James R
Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, UK.
Eur Heart J Case Rep. 2023 Jul 21;7(8):ytad334. doi: 10.1093/ehjcr/ytad334. eCollection 2023 Aug.
Gore Cardioform Atrial Septal Defect Occluder (GCA) is composed of a platinum-filled nitinol wire frame covered with expanded polytetrafluoroethylene (ePTFE). This makes the device highly occlusive and resistant to residual shunts through the device, as well as conforming well to the surrounding anatomy. In defects with poor rims to hold a device for closure or where one of the 'rims' is the free wall of the left ventricle, such as in a post-infarct apical ventricular septal defect (VSD), successful closure with standard nitinol mesh devices can be unachievable.
We present the occlusion of a post-myocardial infarction VSD with a GCA device in a critically ill patient at risk for closure failure and intravascular haemolysis with conventional nitinol mesh devices. The device conformed well to the anatomy even in the absence of an apical interventricular septum.
GCA can be used for intracardiac high-velocity shunts in selected cases where conventional devices are unsuitable due to haemolysis or poor tissue and poor rims. With growing experience using GCA for the closure of atrial septal defects, interventionists should consider the potential advantages of ePTFE material and apply them to other lesions where these could be beneficial for patients.
戈尔心脏成形房间隔缺损封堵器（GCA）由填充铂的镍钛诺丝框架和覆盖有膨体聚四氟乙烯（ePTFE）组成。这使得该装置具有高度的封堵性，能抵抗通过装置的残余分流，并且能很好地贴合周围解剖结构。在边缘条件差无法支撑封堵装置的缺损中，或者其中一个“边缘”是左心室游离壁的情况下，例如在心肌梗死后的心尖室间隔缺损（VSD）中，使用标准镍钛诺网状装置成功封堵可能无法实现。
我们报告了在一名病情危重、有因传统镍钛诺网状装置导致封堵失败和血管内溶血风险的患者中，使用GCA装置封堵心肌梗死后室间隔缺损的情况。即使在没有心尖室间隔的情况下，该装置也能很好地贴合解剖结构。
在某些因溶血或组织条件差、边缘条件差而传统装置不适用的情况下，GCA可用于心内高速分流。随着使用GCA封堵房间隔缺损的经验不断增加，介入医生应考虑ePTFE材料的潜在优势，并将其应用于对患者可能有益的其他病变。
