Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect
Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect
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DOI：
10.1155/2020/6090612
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发表时间：
2020-03-03
影响因子：
2.1
通讯作者：
Ito, Hiroshi
中科院分区：
文献类型：
--
作者：
Takaya, Yoichi;Akagi, Teiji;Ito, Hiroshi
背景资料。在经导管封堵房间隔缺损(ASD)时，间隔排列不良与侵蚀和装置栓塞有关，但可获得的信息有限。目标。本研究旨在评估间隔排列不良的临床意义，并确定房间隔缺损直径的适当评估，包括装置大小的选择。方法：研究方法。入选417例经导管封堵术的房间隔缺损患者。在经食道超声心动图上，间隔排列不良定义为原始间隔和第二间隔之间的分离。结果。184例患者存在室间隔排列不良。在成年患者中，间隔排列不良的频率随着年龄的增长而增加，达到50%左右。室间隔排列不良与主动脉缘发育不全有关。第一隔与第二隔之间的距离为5+/-2 mm(范围1~11 mm)。在室间隔排列不良的患者中，房间隔缺损在房间隔原始位置的直径为19+/-6 mm，而在房间隔第二孔处的直径为16+/-6 mm。房间隔根部测量的ASD直径与隔部测量的ASD直径相差4+/-2 mm(0~8 mm)。在经导管封堵术中，Amplatzer封堵器的封堵器大2-3 mm，Occlutech Figulla Flex II封堵器的封堵器大4-7 mm，封堵器的直径比房间隔原始测定值大4-7 mm。在研究期间，并不是所有的患者都发生侵蚀或装置栓塞。结论。室间隔排列不齐在患有主动脉缘缺陷的成人患者中非常普遍。测量房间隔原始位置的ASD直径对选择间隔排列不良患者的装置大小有价值。
Background. Septal malalignment is related to erosion and device embolization in transcatheter closure of atrial septal defect (ASD), but limited information is available. Objectives. This study aimed to assess clinical significance of septal malalignment and to determine appropriate evaluation of ASD diameter, including the selection of device size. Methods. Four hundred and seventeen patients with ASD who underwent transcatheter closure were enrolled. Septal malalignment was defined as separation between the septum primum and the septum secundum on transesophageal echocardiography. Results. One hundred and eighty-four patients had septal malalignment. The frequency of septal malalignment increased with age reaching around 50% in adult patients. Septal malalignment was related to aortic rim deficiency. The distance of separation between the septum primum and the septum secundum was 5 +/- 2 mm (range, 1-11 mm). In patients with septal malalignment, the ASD diameter measured at the septum primum was 19 +/- 6 mm, while the ASD diameter measured at the septum secundum was 16 +/- 6 mm. There was a difference of 4 +/- 2 mm (range, 0-8 mm) between the ASD diameter measured at the septum primum and that measured at the septum secundum. For transcatheter closure, the Amplatzer Septal Occluder device size 2-3 mm larger and the Occlutech Figulla Flex II device size 4-7 mm larger than the ASD diameter measured at the septum primum were frequently used. During the study period, erosion or device embolization did not occur in all of the patients. Conclusions. Septal malalignment is highly prevalent in adult patients with aortic rim deficiency. The measurement of ASD diameter at the septum primum can be valuable for the selection of device size in patients with septal malalignment.