Zimand S, Birk E, Frand M, Benjamin P, Hegesh J
Dept. of Pediatric Cardiology, Sheba Medical Center, Tel Hashomer.
Harefuah. 1998 Oct;135(7-8):276-9, 335.
The incidence of congenital heart defects is 0.8% of liveborn infants. Of these 13% are ostium secundum atrial septal defects (ASD) which can be successfully repaired by open heart surgery with less than 1% mortality. However, morbidity associated with cardiac surgery is universal. Transcatheter closure of ASDs was introduced 2 decades ago to decrease surgical complications, hospital stay and cost. Few devices have undergone clinical trials but all of them have been associated with instances of failure and complications. The most important mechanism for acute failure was selection of cases with too large a defect or selection of a defective device. In the past decade great progress has been made with the aid of transesophageal echocardiography (TEE) and modifications of the device. We present our experience in our first 5 patients. They ranged in age from 4 to 27 years; the ASD diameter was 11-15 mm and the device diameter was 17-33 mm. All transcatheter closures were performed on the same day without any complications, and all patients were discharged home after 2 days of hospitalization. We conclude that transcatheter occlusion of ASDs up to 15 mm is feasible, relatively safe and effective. This transcatheter method appears to be a viable alternative to surgery for some patients with secundum atrial septal defects.
先天性心脏缺陷的发生率为活产婴儿的0.8%。其中，13%为继发孔房间隔缺损（ASD），可通过心脏直视手术成功修复，死亡率低于1%。然而，心脏手术相关的发病率是普遍存在的。20年前引入了经导管封堵ASD，以减少手术并发症、住院时间和费用。很少有器械进行过临床试验，但所有器械都与失败和并发症的情况有关。急性失败的最重要机制是选择了缺损过大的病例或选择了有缺陷的器械。在过去十年中，借助经食管超声心动图（TEE）和器械的改进取得了很大进展。我们介绍我们最初5例患者的经验。他们的年龄在4至27岁之间；ASD直径为11 - 15毫米，器械直径为17 - 33毫米。所有经导管封堵均在同一天进行，无任何并发症，所有患者住院2天后出院。我们得出结论，对直径达15毫米的ASD进行经导管封堵是可行的、相对安全且有效的。这种经导管方法似乎是一些继发孔房间隔缺损患者手术的可行替代方案。
