经导管封堵治疗成人房间隔缺损合并功能性三尖瓣返流

目的 探讨经导管封堵成人房间隔缺损（atrial septal defect, ASD）后能否改善其合并的功能性三尖瓣返流（tricuspid regurgitation, TR）。方法 连续纳入自2019年1月1日～2020年12月31日在空军军医大学西京医院心血管内科经导管封堵的ASD合并功能性TR患者,根据术前超声心动图评估TR严重程度并进行分级,术后6个月进行超声心动图随访,评估功能性TR的改善程度。结果 与合并轻度TR组相比,合并中/重度TR组患者年龄较大（P<0.01）,ASD直径较大,RV直径较大（均P<0.05）,与合并中度TR组相比,合并重度TR组患者年龄较大（P<0.01）,RV直径较大（P<0.05）。封堵前,11例患者合并重度TR,18例患者合并中度TR, 71例患者合并轻度TR;封堵术后6个月,10例患者（91%）由重度TR降至轻度,12例患者（67%）由中度TR降至轻度。所有患者中无轻度TR患者的返流量增加至中度或重度。单变量分析显示,持续性TR与肺动脉直径、右房直径、右室直径、左房直径、左室直径及ASD大小相关。经过多变量分析,以上...     

Percutaneous closure of a secundum atrial septal defect in elderly patients

Secundum atrial septal defect (ASD) is the most common congenital defect that is initially diagnosed in adult and even in elderly patients. Modern transcatheter technology enables nonsurgical correction of this defect. Previously published studies describe clinical and hemodynamic aspects of ASDs in adults as well as the efficacy and safety of transcatheter ASD closure in this age group. The focus of attention in these studies was on elderly patients (>/= 60 years of age) who underwent transcatheter ASD closure. Elderly ASD patients frequently appeared with hemodynamic abnormalities (pulmonary hypertension, right ventricular failure, etc.) and concomitant pathology. There are limited published data available on the recommended management of ASD in elderly patients. Because of increasing longevity, this has become a persistent issue. The objective of this study was to assess the feasibility and outcome of percutaneous ASD closure in elderly patients (> 60 years of age).     

Pulmonary function changes in children after transcatheter closure of atrial septal defect

This study was performed to assess changes in pulmonary function test (PFT) and pulmonary outcome after transcatheter closure of atrial septal defect (ASD) in pediatric patients. A total 55 pediatric patients undergoing transcatheter ASD closure received PFT at baseline (day before ASD closure), and at 3 days and 6 months after procedure. Forced vital capacity (FVC), forced expired volume in 1 sec (FEV₁), FEV₁ to FVC ratio (FEV₁/FVC), peak expiratory flow (PEF), and mean forced expiratory flow during the middle half of FVC (FEF_25–75) were measured. Individually, subjects were classified by spirometry as normal, obstructive or restrictive, to evaluate the effect of transcatheter closure on pulmonary outcome. These 55 children had significantly reduced mean PEF and FEF_25–75 (84 ± 24%, P = 0.040 and 76 ± 22%, P = 0.010, respectively) at baseline, with FEF_25–75 reduced significantly at 3 days and 6 months (78 ± 24%, P = 0.010 and 81 ± 24%, P = 0.040, respectively) after transcatheter closure. Six months after transcatheter closure of ASD, significant improvement was observed in mean FVC (94 ± 19% vs. 98 ± 15%, P = 0.034) and FEV₁ (90 ± 20% vs. 96 ± 19%, P = 0.008). Assessed individually, better pulmonary outcome was found in patients without pulmonary hypertension (PH) (χ² = 8.333, P = 0.044). PFT disturbance was observed in significant flow limitation in the peripheral airway of ASD patients. Improved PFT was found after transcatheter closure and better pulmonary outcome was observed in patients without PH. ASD children need monitoring pulmonary function and should receive transcatheter closure before PH develops. Pediatr Pulmonol. 2009; 44:1025–1032. ©2009 Wiley‐Liss, Inc.     

Long-term Outcomes of Adults With Tricuspid Regurgitation Following Transcatheter Atrial Septal Defect Closure

BackgroundFunctional tricuspid regurgitation (TR) is a common pathophysiologic condition in adults with ostium secundum atrial septal defect (ASD). The aim of this study was to evaluate long-term outcomes following transcatheter ASD closure, which have not been well studied among patients with significant TR.MethodsWe reviewed consecutive adult patients who underwent transcatheter ASD closure at Toronto General Hospital, Ontario, Canada, from 1998 to 2016. We linked our hospital registry with Ontario population-based health administrative databases to collect longitudinal data on inpatient and outpatient health care utilisation and vital status.ResultsIn this cohort study of 949 patients, 199 (22%) had moderate to severe TR before transcatheter ASD closure. A significant proportion of patients (61%) showed improvement in TR severity to at least mild TR after ASD intervention. At a median follow-up of 10.9 years, patients with baseline mild or no TR, compared with those with greater than moderate TR, had significantly lower rates of all-cause mortality (6.8 vs 22.5 per 1000 person-years [PY]; P < 0.001), composite hospitalisation for atrial fibrillation (AF) or heart failure (HF) (22.3 vs 49.1 per 1000 PY; P < 0.001), and new onset of AF (10.4 vs 20.2 per 1000 PY; P = 0.002) and HF (5.0 vs 9.2 per 1000 PY; P = 0.039). Preprocedural TR was independently associated with higher all-cause mortality (adjusted hazard ratio 1.69, 95% confidence interval 1.08-2.62).ConclusionsTR severity was independently associated with a higher risk of mortality and morbidity. Further investigation of earlier device closure or concomitant tricuspid valve intervention may be of interest.     

Transcatheter closure of atrial septal defect without balloon sizing

Objective: To evaluate the safety and feasibility of transcatheter closure of atrial septal defect (ASD) without balloon sizing. Methods: A total of 243 patients (group I), aged 2.1–76 years (median 22 years), underwent transcatheter closure of ASD without balloon sizing. The maximal diameter of the defect was measured on transesophageal echocardiographic (TEE) images. The size of device selected was generally 4–6 mm and 5–8 mm larger than the maximal diameter, if the defect was <14 mm and ≥14 mm, respectively. The results of ASD closure in group I were compared with those of 271 patients (group II, median age 11 years) who underwent ASD closure with balloon sizing prior to the study period. Results: Of the 243 patients in group I, the maximal defect diameter ranged from 5.2 to 37 mm (mean 17.5 ± 6.6 mm, median 17 mm). A total of 247 Amplatzer septal occluders were deployed in 240 patients. Two patients were found to develop distal embolization of a device the next day. Therefore, failure occurred in five patients. Comparing the results between group I and group II, there was no significant difference in success rate (238/243 vs. 263/271), incidence of embolization (2/243 vs. 2/271) and complete closure rate at 3‐month follow‐up (94.1% vs. 95.8%). There is significant difference in mean age (26.6 ± 20.2 vs. 19.1 ± 17.6), maximal defect diameter (17.5 ± 6.6 vs. 14.1 ± 5.9 mm) and Q_p/Q_s ratio (2.77 ± 1.11 vs. 2.48 ± 0.97) between group I and II. The mean diameter of device used was significantly larger in group I than in group II (23.1 ± 8.1 vs. 19.6 ± 7 mm, P < 0.001). Conclusions: Balloon sizing may not be necessary in transcatheter closure of ASD. © 2008 Wiley‐Liss, Inc.     

介入封堵术在老年继发孔型房间隔缺损患者中的临床应用

目的观察老年继发孔型房间隔缺损(ASD)患者进行介入封堵术的中、远期疗效和安全性。方法老年继发孔型ASD患者206例,缺损8～38(26.5±8.1)mm。封堵术前、术后行右心导管检测肺动脉压、右心室压,随访6个月,评价心功能(NYHA)改善情况。结果成功封堵203例,成功率98.5%。封堵器直径12～42(31.5±7.3)mm。与封堵术前比较,患者封堵术后肺动脉收缩压、右心室平均压明显下降(P<0.05,P<0.01);3～6个月随访时,患者右心室容积缩小、LVEF升高、心功能改善明显。术后心包积液1例(0.5%);即刻残余分流10例(4.9%);术后出现心律失常30例(14.8%)、出现急性心功能不全16例(7.9%)。6个月随访,患者均未发现有残余分流、脱落、栓塞。结论老年继发孔型ASD患者行介入封堵治疗中、远期相对安全、有效。     

老年房间隔缺损患者介入治疗的临床分析

目的 探讨老年房间隔缺损患者的临床特征及行经导管封堵治疗的安全性和有效性.方法 入选2000年5月至2010年6月行经导管封堵治疗的(64.5±3.8)岁房间隔缺损患者82例.经导管封堵术中行右心导管检查.术后1d、1个月、3个月和6个月进行随访.分析老年房间隔缺损患者的临床特征,观察房间隔缺损封堵前后肺动脉压及心功能的改变情况.结果 82例房间隔缺损患者中,合并肺动脉高压37例,发生率为45.1％.封堵前的右心导管检查显示,患者肺动脉收缩压为(44.1±12.4)mm Hg(1 mm Hg=0.133 kPa),肺动脉平均压为(25.2 +6.8)mm Hg.1例重度肺动脉高压患者不适宜经导管封堵治疗,其余81例均成功行介入治疗,无手术相关并发症.36例封堵成功的肺动脉高压患者肺动脉收缩压由术前的(52.7±10.3)mm Hg下降至术后的(31.8 +6.3)mm Hg(P＜0.05),肺动脉平均压由术前的(30.9±4.7) mm Hg下降至术后的(21.8±3.4) mm Hg(P＜0.05).与术前比较,术后1d、1个月、3个月和6个月NYHA心功能分级改善.术后新发心房颤动6例.结论 老年房间隔缺损患者通常合并肺动脉高压.只要严格掌握适应证和规范操作,经导管封堵治疗老年房间隔缺损仍是一种安全有效的方法.     

Effects of age on hemodynamic changes after transcatheter closure of atrial septal defect: importance of ventricular diastolic function

Some older patients develop symptoms of clinical heart failure after closure of an atrial septal defect (ASD). The present study tested the hypothesis that baseline hemodynamics and hemodynamic changes induced by transcatheter ASD closure are different between younger and older patients due to age-related differences in left ventricular (LV) diastolic dysfunction. Forty-three consecutive patients (27.7 ± 16.3 years of age, range 5–63, median 25) who underwent device closure for ASD were divided into younger (age ≤25, n = 24, 15.1 ± 1.2 years) and older (> 25 years, n = 19, 43.7 ± 2.2 years) groups. Echocardiographic evaluations were performed 1 day before and 2 days after ASD closure. Before ASD repair, early diastolic mitral annular velocity (e′) on lateral, an index of ventricular relaxation, showed an age-related decrease. After closure, e′ decreased by similar amount in both groups (p < 0.05). In addition, E/e′, an index of LV filling pressure, was relatively unchanged in the younger group (from 5.4 to 5.9) but significantly increased (p < 0.05) in the older group (from 6.3 to 8.1) over similar increase of normalized LV diastolic dimension. In older patients, ASD closure resulted in further deterioration of baseline impairment in LV relaxation and the increased LV stiffness caused a more marked rise in LV filling pressure, compared to the younger group. Thus, ASD should be closed at a younger age before the development of age-related LV diastolic dysfunction.     

Beneficial effects of transcatheter closure of atrial septal defects not only in young adults

Objectives: To compare cardiac events and remodeling effects after transcatheter closure of atrial septal defects (ASD) in pediatric, adult, and older adult patients. Methods: A retrospective review was conducted of 353 patients who underwent transcatheter ASD closure between February 1999 and December 2007 at Siriraj Hospital. The patients were divided into 3 groups according to age: children (<18 years; n = 99); adults (18–50 years; n = 169); and older adults (>50 years; n = 85). Cardiac events at 1 year, and changes in left and right ventricular dimensions between preprocedure and 6 months and 1 year postprocedure were compared between groups. Results: Of the 353 patients, the average size of ASD was 22.1 ± 6.6 mm. Device: ASD diameter was 1.25 ± 0.28 mm. At 1 year postprocedure, the prevalence of chest discomfort and atrial fibrillation (AF) was higher in older adult patients, compared to the other age groups. Device embolization, cardiac erosion, pericardial effusion, syncope, migraine, thrombus formation, and residual shunt did not differ between groups. Within the first 6 months, the right ventricular (RV) dimension tended to dramatically decrease, while the left ventricular (LV) dimension increased in all age groups. These changes leveled off in children and in older adults, but in the adult group (18–50 years), RV shrinkage and LV expansion continued for 1 year. A low rate of early and late complications was noted. Conclusion: Transcather closure of ASD can cause cardiac remodeling, regardless of the patient's age at the time of the procedure. For older adult patients, the long‐term risk of AF continuation and chest discomfort is likely. (J Interven Cardiol 2012;25:382–390)     

中老年房间隔缺损患者介入治疗前心脏CT检查的价值

目的 评估心脏CT在筛查拟行房间隔缺损(ASD)封堵术中老年患者合并的心血管病变及指导封堵器选择方面的价值。方法 对63例拟行ASD封堵术的50 ～ 77( 56.87±5.79)岁患者行冠状动脉CT造影检查,了解心血管病变情况。随后行ASD三维重建,并测量ASD大小。分析经胸超声心动图与CT的ASD直径测量值之间以及ASD直径的CT测量值与ASD封堵器腰部直径之间的关系。结果 14例患者依据心脏CT检查结果调整了治疗方案：8例患者诊断为ASD合并冠心病,均行常规冠心病治疗,其中2例患者行经皮冠状动脉介入治疗和ASD封堵术,1例患者行冠状动脉旁路移植术和ASD封堵术,5例患者行药物治疗和ASD封堵术;2例患者因ASD后下缘残端不完整,而放弃介入治疗;1例患者超声心动图示ASD后下缘残端不完整,而CT显示缺损边缘尚可,行ASD封堵术;除外ASD 1例;合并部分型肺静异位引流(PAPVC)1例,行外科修补术;合并动脉导管未闭1例,行动脉导管未闭和ASD封堵术。经胸超声心动图与CT的ASD直径测量值之间呈正相关(r=0.80,P＜0.01),其线性回归方程为Y=0.84X +8.85(R2=0.63,P＜0.05)。ASD直径的CT测量值与ASD封堵器腰部直径之间呈正相关(r=0.92,P＜0.01),其线性回归方程为y=0.93X +4.78(R2=0.84,P＜0.05)。结论 对于拟行ASD封堵术的中老年患者,术前心脏CT检查可有效诊断合并的冠心病及其他心血管畸形,并能指导封堵器的选择。     

Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects

OBJECTIVES: We set out to study the effect of transcatheter closure of atrial septal defect (ASD) on right ventricular (RV) and left ventricular (LV) function assessed by myocardial performance index (MPI), as well as left atrial (LA) volumes. BACKGROUND: The hemodynamic response to the closure of ASD is well-documented in surgically treated patients. However, few studies have documented echocardiographic evaluation of ventricular function in patients undergoing transcatheter closure of ASDs. METHODS: Pre- and post-ASD device closure echocardiograms of 25 consecutive patients were retrospectively reviewed. Measurements of RV and LV MPI and LA volumes were made. RESULTS: Twenty-five patients with an average age of 45.5 +/- 16.3 years underwent transcatheter closure of ASD. There was statistically significant improvement in RV MPI (0.35 to 0.28, p = 0.004), LV MPI (0.37 to 0.31, p = 0.04), and LA volume index (25.7 to 21.8 ml/m(2), p < 0.001) after closure of ASD. CONCLUSIONS: Device closure of ASDs leads to improvement of both RV and LV function as well as reduction in LA volume. These hemodynamic improvements provide insights into the symptomatic benefits gained in closure of ASDs using the transcatheter approach.     

Percutaneous transcatheter closure of interatrial septal defect in adults: Procedural outcome and long‐term results

Background : Percutaneous transcatheter closure of patent foramen ovale (PFO) and atrial septal defect (ASD) has been shown to be feasible. Aim : The aim of this study was to evaluate the safety and efficacy of transcatheter interatrial septal shunt closure with prosthesis implantation in adults patients during long‐term follow‐up. In addition, the impact of thrombophilia and pulmonary hypertension on the outcome were investigated. Methods : Between June 1999 and November 2009, 287 patients (112 males, 43 ± 14 years) were treated in our institution by transcatheter closure of PFO (N = 175) or ASD (N = 112). Clinical and echocardiographic follow‐up were prospectively performed at 1, 6 and 12 months followed by a 1 once a year evaluation. Results : All procedures were successful with eight procedural complications (2.7%): one stroke, two femoral pseudoaneurysms, three transient atrial fibrillation, two minors pericardial effusions. Among patients with presumed paradoxical embolism, thrombophilia was observed in 29 patients (17%); only one of them experienced a recurrent stroke. Among patients with ASD, pulmonary hypertension was observed in 32 cases (28%) and significantly reduced 6 months after shunt closure (from 47 ± 7 to 31 ± 11 mm Hg, P < 0.0001). 99% of patients achieved a complete follow‐up. Clinical improvement was observed in 93%. Freedom from death, cardiac surgery or recurrent embolism was 98 ± 1% at 5 years. Conclusion : Percutaneous transcatheter interatrial septal defect closure is a safe and effective treatment in adults patients, even in case of thrombophilia or pulmonary hypertension, during a long‐term follow‐up, up to 11 years. © 2011 Wiley Periodicals, Inc.     

Simultaneous percutaneous atrial septal defect closure and percutaneous coronary intervention.

OBJECTIVE: To evaluate the possibility to perform both percutaneous coronary interventions (PCI) and atrial septal defect (ASD) transcatheter treatment during the same session. Transcatheter ASD closure is a well-established alternative to surgery and the treatment of choice for single vessel coronary artery disease (CAD) is accepted to be PCI. METHODS: From January 2000 to December 2005, 985 patients were referred to our center for ASD closure. One hundred thirty four patients (59 males, mean age 58 +/- 4 years, range 45-72 years) were included in a prospective protocol of ASD transcatheter closure and coronary angiography. RESULTS: In 7 patients we found a coronary artery disease. A combined single setting definitive percutaneous approach (ASD closure and PCI) was performed in 6 patients. The patient number 4 was judged unsuitable for PCI and then was referred for surgery. There was no acute intra-procedural complication in all patients; renal functions pre and post procedure showed no change despite the increase in the amount of contrast used. CONCLUSION: Our report showed the feasibility of both PCI and ASD transcatheter treatment during the same session.     

The impacts of transcatheter occlusion for congenital atrial septal defect on atrial volume, function, and synchronicity in children: a three-dimensional echocardiography study

Objective: To evaluate the impacts of transcatheter closure for atrial septal defect (ASD) on the atria. Methods: Thirty‐four patients with ASD undergoing transcatheter occlusion were recruited in the study, and 34 patients undergoing surgical operation and 34 healthy children were age‐matched as controls. A real time three‐dimensional (RT3DE) echocardiography was used to measure the volume, function, and synchronicity of the atria. Results: There was no difference in the atrial volume and function between the transcatheter occlusion group and healthy control group (P > 0.05). However, the parameters reflecting the atrial asynchrony were larger in the transcatheter occlusion group (P < 0.05). Compared to the surgical repair group, the transcatheter occlusion group had smaller maximum volume of the left atrium (21.0 ± 5.2 ml/m² vs 24.3 ± 5.8 ml/m², P = 0.01), smaller total emptying volume of the left atrium (12.7 ± 4.3 ml/m² vs 15.1 ± 3.8 ml/m², P = 0.014), smaller total emptying volume of the right atrium (13.5 ± 5.2 ml/m² vs 16.1 ± 4.7 ml/m², P = 0.029), and larger atrial systolic asynchrony indices. Conclusions: An atrial asynchrony is observed in patients with transcatheter closure of ASD, although little negative impacts on the atrial volume and function are demonstrated, which deserves more attention during follow‐up of this specific population.     

Assessment of the markers of platelet and coagulation activation following transcatheter closure of atrial septal defects

BACKGROUND: Aspirin has been routinely prescribed following transcatheter closure of secundum atrial septal defects (ASDs) but its rationale has not been clinically or biologically evaluated; and despite aspirin, thrombotic complications occur following transcatheter ASD closure. We therefore evaluated the presence, degree and timing of the activation of the coagulation and platelet systems following transcatheter closure of ASDs. METHODS AND RESULTS: Fourteen consecutive patients (9 females, mean age 41+/-22 years) who underwent successful transcatheter closure of an ASD defect with the Amplatzer septal occluder were prospectively studied. Measurements of the prothrombin fragment 1+2 (F1+2) levels and the percentage of activated platelets (determined by P-selectin expression detected by flow cytometry) were taken at baseline just before the procedure, and at 1, 7, 30 and 90 days following device implantation. F1+2 levels increased from 0.85+/-0.29 nmol/l at baseline to a maximal value of 1.20+/-0.52 nmol/l at 7 days, gradually returning to the baseline levels at 90 days (0.79+/-0.54 nmol/l) (p<0.001). F1+2 levels at 7 days were also significantly higher than those obtained in a control group of 20 healthy subjects (p=0.016). A greater increase in coagulation activation was observed in cases of residual shunt following ASD closure (r=0.53, p=0.050). No significant variations in the percentage of platelets expressing P-selectin were detected at any time. CONCLUSIONS: Transcatheter closure of ASDs with the Amplatzer septal occluder was associated with a significant increase in F1+2 levels during the first week after device implantation, but there was no detectable effect on platelet system activation. These findings raise the question whether the optimal prophylactic approach following transcatheter ASD closure should be anticoagulant instead of antiplatelet therapy.     

Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect

Background: Right ventricular (RV) volume overload is a well‐known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long‐term complications. Thus cardiac volumetric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD. Methods: We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transthoracic echocardiographic studies, including three‐dimensional echocardiography and right ventricular myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure. Results: We found that: (1) the right ventricular end‐diastolic volume (RVEDV) and right ventricular end‐systolic volume (RVESV) (respectively 106.54±25.97 vs 69.78±10.46 mL, P < 0.05; 59.73±17.59 vs 33.84±7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ventricular ejection fraction (RVEF) (44.82%±4.51% vs 54.11%±5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61±16.49] ms vs (64.09±11.82) ms, P < 0.05; [28.04±9.57] ms vs [20.45±6.53] ms, P < 0.05) were prolonged and ejection time ([250.02±24.21] ms vs [272.73±20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41±0.07 vs 0.31±0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly. Conclusions: Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

Iatrogenic cardiac arrhythmias following transcatheter or surgical closure of atrial septal defect in children

BACKGROUND: Invasive procedures involving the atria may promote the development of iatrogenic cardiac arrhythmias. AIM: To analyse the prevalence of cardiac arrhythmias following transcatheter or cardiosurgical closure of the secundum type atrial septal defect (ASD). METHODS: The study group consisted of 91 patients, aged 2-18 years with haemodynamically significant ASD who underwent surgical (n=44) or transcatheter (Amplatzer occluder) (n=47) closure of ASD. Standard ECG and Holter ECG recordings, obtained before and after the procedure, were analysed. The follow-up duration ranged from 2.5 to 5.5 years. Cardiac arrhythmias were divided into benign or significant (requiring pharmacological therapy), early or late, and transient or permanent. RESULTS: Cardiac arrhythmias were detected in 16 (36%) patients who underwent surgery compared with 1 (2.1%) patient who underwent transcatheter ASD closure (p<0.05). In surgically treated patients, arrhythmias were benign in 9 patients, significant in 7 children, early in 15 subjects, late in one patient, transient in 13 children and permanent in 3 subjects. One patient, who underwent transcatheter ASD closure, developed paroxysmal supraventricular tachycardia one day after the procedure, successfully terminated with verapamil. CONCLUSIONS: Transcatheter closure of ASD is associated with a lower risk of procedure-related arrhythmias than surgical treatment. However, longer follow-up in patients treated with transcatheter procedure is needed in order to draw definite conclusions.     

经导管封堵术治疗房间隔缺损疗效观察及护理体会

为全面了解经导管封堵术(下称封堵术)治疗房间隔缺损(ASD)的优缺点，探讨护理及预防并发症发生的方法，我们对采用封堵术的30例继发孔型ASD患者(封堵组)的临床资料进行回顾性分析，并与同期30例行开胸手术患者(手术组)作对照。结果封堵组与手术组平均年龄、ASD缺损平均直径差异无显著性，手术成功率均为100％；封堵组手术时间、监护时间、住院时间均较手术组明显缩短，且不需输血，术后无疤痕及并发症发生；但平均住院费用较手术组高。提示封堵术在其适应证范围内可替代开胸手术；优良的护理对提高手术成功率、减少并发症有重要作用。     

Echocardiographic Estimates of Left Ventricular Diastolic Dysfunction Do Not Predict the Clinical Course in Elderly Patients Undergoing Transcatheter Atrial Septal Defect Closure: Impact of Early Diastolic Mitral Annular Velocity

Objective

This study evaluated the effect of echocardiographic left ventricular (LV) diastolic dysfunction on acute congestive heart failure after transcatheter atrial septal defect (ASD) closure in elderly patients.

Background

Although there is concern that LV diastolic dysfunction develops acute congestive heart failure after ASD closure, limited information is available regarding the influence, especially in elderly patients with severe LV diastolic dysfunction.

Methods

Two hundred consecutive patients older than 60 years were divided into 3 groups according to echocardiographic LV diastolic dysfunction: severe (early diastolic mitral annular velocity [e’] <5.0 cm/s), mild (5.0≤ e’ <8.0 cm/s), and normal (e’ ≥ 8.0 cm/s). Changes in plasma B‐type natriuretic peptide (BNP) levels were evaluated.

Results

No patients with severe LV diastolic dysfunction developed acute congestive heart failure immediately after the procedure. BNP levels unchanged after the procedure in patients with severe LV diastolic dysfunction (126 ± 181 to 131 ± 148 pg/ml, P = 0.885), and this increase in BNP levels was not different from that between the diagnosis of ASD and the procedure. The change in BNP levels in patients with severe LV diastolic dysfunction, who were frequently treated with diuretics before the procedure, was equivalent to that in patients with mild LV diastolic dysfunction and normal LV diastolic function (5 ± 119 vs. 16 ± 101 vs. 9 ± 131 pg/ml, P = 0.724).

Conclusions

Our findings suggest that transcatheter ASD closure under volume management is safe and valuable in elderly patients with echocardiographic severe LV diastolic dysfunction.

     

Safety and Long‐Term Outcome of Modified Intracardiac Echocardiography‐Assisted “No‐Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect

Background: The need for sizing the secundum atrial septal defect (ASD) with the balloon sizing technique is still debated at least in adult patients. We sought to prospectively evaluate the effectiveness of intracardiac echocardiography (ICE)‐aided sizing technique for transcatheter closure of secundum ASD, without using a balloon sizing. Methods: In a prospective 5‐year registry, we enrolled 81 patients (mean age 48 ± 13.7 years, 54 females) who had been referred to three different centers for catheter‐based closure of secundum ASD. Eligible patients underwent ICE study and closure attempt. In a preliminary group of 21 patients, sizing balloon was performed under ICE guidance to assess the value of rim thickness necessary for device anchorage. In the remaining 60 patients, the retrieved value of the rim thickness was measured on ICE and used as key points to measure the defect and select the device. Results: In the preliminary group of patients, the value of thickness at point of initial deflection by the balloon was 1.23 ± 0.1 mm. ASD diameter in the study group was measured at the point of rim with at least 1.2 mm and the mean ASD diameter was 26.2 ± 10.1 mm. Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 93.3%, and 0%, respectively. On mean follow‐up of 5.4 ± 1.8 years, the occlusion rate was 98.7% with no long‐term complications. Conclusions: Our novel ICE‐sizing technique appears to be safe and effective in adult patients, thus eventually minimizing overestimation, costs, and potential complications of balloon sizing. (J Interven Cardiol 2012;25:628–634)