Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia.
Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia.
BMC Cardiovasc Disord. 2024 Oct 3;24(1):534. doi: 10.1186/s12872-024-04165-7.
An atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population.
To assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs.
This single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio < 0.75, a circular index of 1.33, or ultrasound visualization of an oval shape. Device size was chosen to be 0-4 mm larger than the defect's longest diameter, based on transthoracic and transesophageal ultrasound measurements.
We identified 78 patients (33.3% children, 20.5% males) with a mean age of 27.4 ± 16.3 years and a mean weight of 46.8 ± 19.8 kg. The mean longest diameter and mean shortest diameter of ASDs were 23.3 ± 6.8 mm and 15.8 ± 5 mm, respectively. The mean ratio of the shortest to longest diameter was 0.7 ± 0.1. Percutaneous closure was not attempted in 7/78 (9%) patients. Three out of 71 (4.2%) procedures were fluoroscopy-guided upfront due to technical difficulties, and 5/71 (7%) were converted to fluoroscopy-guided closure. Overall procedural success rate was 98.6% (70/71) including 63/71 (88.7%) performed with zero fluoroscopy. Mean device size was 26.5 ± 7.1 mm. Mean procedural time was 45.3 ± 22.6 min. Eleven intraprocedural complications occurred including 6 arrhythmias, 3 pericardial effusions, and 2 device dislodgements.
Transcatheter closure of oval-shaped ASD is safe and feasible. Echocardiography is adequate for adequate operative guidance.
当房间隔缺损（ASD）的最短直径小于最长直径的 75%时，该缺损被认为呈椭圆形。对于经皮闭合椭圆形 ASD 的研究有限，对于该人群，尚无非透视闭合的相关报道。
评估非透视经皮闭合椭圆形 ASD 的有效性。
本单中心回顾性研究评估了接受非透视经皮闭合椭圆形 ASD 的患者，这些 ASD 的最短至最长直径比 < 0.75，圆形指数为 1.33，或超声显示为椭圆形。根据经胸和经食管超声测量，选择比缺损最长直径大 0-4 毫米的器械尺寸。
我们确定了 78 例患者（33.3%为儿童，20.5%为男性），平均年龄为 27.4 ± 16.3 岁，平均体重为 46.8 ± 19.8kg。ASD 的平均最长直径和平均最短直径分别为 23.3 ± 6.8mm 和 15.8 ± 5mm，最短至最长直径比的平均值为 0.7 ± 0.1。78 例患者中有 7/78（9%）未尝试经皮闭合。由于技术困难，71 例中有 3 例（4.2%）手术开始时采用透视引导，5 例（7%）转为透视引导闭合。总体手术成功率为 98.6%（70/71），包括 63/71（88.7%）例零透视手术。平均器械尺寸为 26.5 ± 7.1mm。平均手术时间为 45.3 ± 22.6min。11 例术中并发症包括 6 例心律失常、3 例心包积液和 2 例器械移位。
经导管闭合椭圆形 ASD 是安全可行的。超声心动图足以提供充分的手术指导。
