Kaulitz R, Paul T, Hausdorf G
Department of Paediatric Cardiology, Children's Hospital, Hannover Medical School, Germany.
Heart. 1998 Jul;80(1):54-9.
To report initial findings from a selected group of patients with morphological variations of the atrial septal defect who underwent transcatheter closure with a second generation redesigned double umbrella device.
Two patients with abnormal location of the oval fossa and partial deficiency of the septal rim, three patients with multiple defects, and two patients with a multiperforated aneurysm of the interatrial septum (age range, 3.6-25.5 years).
Defects were closed with the double umbrella device (CardioSEAL) consisting of two sets of flexible arms (with central and two mid-arm hinges) covered with sewn Dacron patches. The implantation procedure was monitored by transoesophageal echocardiography.
The diameter of the defect measured during transoesophageal echocardiography ranged from 7-18 mm and the balloon stretched diameter ranged from 13-21 mm. The size of the devices varied from 28-33 mm and the ratio of device size to defect size varied from 1.6-2.1. Two devices (23 and 28 mm) were chosen in a patient with two separated defects. No complications or serious arrhythmias were observed during implantation or follow up (median, 1.8 months). Residual shunting was trivial in three patients and mild in one patient (inferiorly located additional defect).
To extend the selection critera of an isolated central interatrial defect for transcatheter closure, some modifications of the implantation technique are needed. Using the redesigned double umbrella device, effective closure in patients with multiple or irregularly shaped atrial septal defects was achieved, indicating a broadening of the spectrum of transcatheter closure.
报告一组经导管使用第二代重新设计的双伞装置关闭房间隔缺损形态变异患者的初步研究结果。
两名卵圆窝位置异常且房间隔边缘部分缺损的患者，三名存在多个缺损的患者，以及两名房间隔多孔瘤患者（年龄范围为3.6 - 25.5岁）。
使用由两组柔性臂（带有中央和两个臂中部铰链）覆盖缝有涤纶补片的双伞装置（CardioSEAL）关闭缺损。植入过程通过经食管超声心动图监测。
经食管超声心动图测量的缺损直径为7 - 18毫米，球囊扩张直径为13 - 21毫米。装置尺寸为28 - 33毫米，装置尺寸与缺损尺寸之比为1.6 - 2.1。一名有两个分离缺损的患者选用了两个装置（23和28毫米）。植入或随访期间（中位时间为1.8个月）未观察到并发症或严重心律失常。三名患者残余分流轻微，一名患者（下方存在额外缺损）残余分流轻度。
为扩大经导管关闭孤立性中央房间隔缺损的选择标准，需要对植入技术进行一些改进。使用重新设计的双伞装置，可有效关闭多个或形状不规则的房间隔缺损患者的缺损，表明经导管关闭的范围有所拓宽。
