Prakoso Radityo, Ariani Rina, Kurniawati Yovi, Siagian Sisca Natalia, Sembiring Aditya Agita, Sakti Damba Dwisepto Aulia, Kuncoro B R M Ario Soeryo, Mendel Brian, Rudiktyo Estu, Soesanto Amiliana Mardiani, Lelya Olfi, Lilyasari Oktavia
Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia.
Division of Non-invasive Diagnostic and Cardiovascular Imaging, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia.
Front Cardiovasc Med. 2025 Apr 4;12:1430555. doi: 10.3389/fcvm.2025.1430555. eCollection 2025.
Zero-fluoroscopy, exclusively ultrasound-guided atrial septal defect (ASD) catheter closure has been reported. However, data on the effectiveness of this technique in complex cases remains limited.
This study aims to evaluate the safety, efficacy, and outcomes of ASD catheter closure using exclusive ultrasound guidance, with a particular focus on complex cases.
We conducted a retrospective review of clinical data from patients who underwent attempted ASD catheter closure with exclusive ultrasound guidance at our institution between July 2018 and April 2024. Patients were categorized into two groups based on the complexity of their cases (simple vs. complex ASD cases). Complex cases included patients with large defects (≥25 mm), multiple or fenestrated ASDs, deficient posterior-inferior rim <3 mm, deficient retro-aortic rim <5 mm, pulmonary hypertension, septal malalignment, and pregnancy. We analyzed and compared demographic information, procedural data, and outcomes between the two groups.
We identified 339 patients (18.2% males, 53.6% adults) with a median age of 21 years (IQR, 9-38) and median weight of 46.5 Kg (IQR, 22-59). Overall, median defect size was 20 mm (IQR, 16-25) and device size was 26 mm (IQR, 20-32). 248 (73.1%) patients were classified as complex including 98 (28.9%) with large defects (≥25 mm), 33 (9.7%) with multiple or fenestrated ASDs, 53 (15.6%) with pulmonary hypertension, 171 (50.4%) with rim deficiency, 50 (14.7%) with septal malalignment, and 6 (1.7%) with pregnancy. Two procedures (0.5%) were guided using transthoracic ultrasound and 337 (99.4%) using both transthoracic and transoesophageal ultrasound. The implantation success rate was 98.9% in simple cases and 97.1% in complex cases ( < 0.001). The rate of conversion to fluoroscopy guidance was 0 (0%) in simple cases and 7 (2.8%) in complex cases ( < 0.001). The median procedural time was 41 min (IQR, 30-47) in simple cases and 45 min (IQR, 36-62) in complex cases ( = 0.008). Sixteen patients (4.7%) underwent balloon-assisted procedures, and 12 (3.5%) required redeployment. There were 6 (1.7%) serious procedural complications (0 in simple cases, 6 in complex cases). The median follow-up was 187 days (IQR, 21-428.7). There were no residual shunt at latest follow-up for both simple and complex cases.
Zero-fluoroscopy exclusively echocardiography-guided ASD closure is effective in both simple and complex cases. However, the rate of conversion to fluoroscopy and implantation failure are significantly higher in complex ASD cases.
已有报道称可在完全超声引导下进行零荧光透视房间隔缺损（ASD）导管封堵术。然而，关于该技术在复杂病例中的有效性的数据仍然有限。
本研究旨在评估完全超声引导下ASD导管封堵术的安全性、有效性及结果，尤其关注复杂病例。
我们对2018年7月至2024年4月期间在本机构接受完全超声引导下ASD导管封堵术尝试的患者的临床资料进行了回顾性分析。根据病例的复杂性将患者分为两组（简单ASD病例与复杂ASD病例）。复杂病例包括有大缺损（≥25 mm）、多发或多孔型ASD、后下边缘缺损<3 mm、主动脉后边缘缺损<5 mm、肺动脉高压、房间隔排列不齐及妊娠的患者。我们分析并比较了两组之间的人口统计学信息、手术数据及结果。
我们纳入了339例患者（男性占18.2%，成年人占53.6%），中位年龄为21岁（四分位间距，9 - 38岁），中位体重为46.5 kg（四分位间距，22 - 59 kg）。总体而言，中位缺损大小为20 mm（四分位间距，16 - 25 mm），封堵器大小为26 mm（四分位间距，20 - 32 mm）。248例（73.1%）患者被归类为复杂病例，其中包括98例（28.9%）大缺损（≥25 mm）、33例（9.7%）多发或多孔型ASD、53例（15.6%）肺动脉高压、171例（50.4%）边缘缺损、50例（14.7%）房间隔排列不齐及6例（1.7%）妊娠患者。2例手术（0.5%）采用经胸超声引导，337例（99.4%）采用经胸和经食管超声引导。简单病例的植入成功率为98.9%，复杂病例为97.1%（<0.001）。简单病例中转至荧光透视引导的比例为0（0%），复杂病例为7例（2.8%）（<0.001）。简单病例的中位手术时间为41分钟（四分位间距，30 - 47分钟），复杂病例为45分钟（四分位间距，36 - 62分钟）（P = 0.008）。16例患者（4.7%）接受了球囊辅助手术，12例（3.5%）需要重新放置封堵器。有6例（1.7%）严重手术并发症（简单病例中0例，复杂病例中6例）。中位随访时间为187天（四分位间距，21 - 428.7天）。在最近一次随访时，简单病例和复杂病例均无残余分流。
完全超声心动图引导下的零荧光透视ASD封堵术在简单病例和复杂病例中均有效。然而，复杂ASD病例中转至荧光透视引导的比例及植入失败率显著更高。
