Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure
Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure
复制标题
临时球囊封堵试验可能高估经导管房间隔缺损封堵术后发生急性肺水肿的风险
DOI：
10.1002/ccd.30556
复制
发表时间：
2023
影响因子：
2.3
通讯作者：
Ito Hiroshi
中科院分区：
文献类型：
--
作者：
Nakagawa Koji;Akagi Teiji;Takaya Yoichi;Miki Takashi;Kijima Yasufumi;Nakayama Rie;Toh Norihisa;Nishii Nobuhiro;Nakamura Kazufumi;Morita Hiroshi;Ito Hiroshi
房间隔缺损（ASD）封堵术可引起急性肺水肿。在进行经导管封堵术之前，建议对左心室功能不全的患者进行暂时性球囊闭塞试验（BOT），以预测肺水肿的风险。然而，BOT的准确性尚未得到验证。本研究旨在比较BOT和transcatheter closure.MethodsA之间的血流动力学差异，共42例年龄超过18岁的单一ASD患者在2010年10月至2020年5月期间接受经导管ASD封堵术前接受BOT。在基线、BOT 10分钟后和经导管封堵后，使用放置在肺动脉中的Swan-Ganz导管测量肺毛细血管楔压（PCWP）。Amplatzer间隔封堵器用于所有经导管封堵术。结果患者平均年龄为64 ± 18岁（范围：18 - 78岁）。平均ASD直径和肺动脉与体循环血流比分别为18 ± 5和2.8 ± 1.0 mm。基线、BOT期间和经导管封堵术后的平均PCWP分别为8.9 ± 2.9、13.5 ± 4.2和9.5 ± 2.6 mmHg。BOT与经导管封堵后的值之间差异有显著性（p< 0.001）。7例ASD封堵术后PCWP均<18 mmHg，无一例发生急性肺水肿。结论ASD球囊封堵术与经导管封堵术的血流动力学改变不同。BOT高估了经导管ASD封堵后PCWP的增加，需要仔细解释。需要在高风险患者中进行设计良好的大型研究，以更详细地验证BOT的临床意义。
BackgroundAtrial septal defect (ASD) closure can cause acute pulmonary edema. Before transcatheter closure is performed, temporary balloon occlusion test (BOT) is recommended in patients with left ventricular dysfunction to predict the risk of pulmonary edema. However, the accuracy of BOT has not been verified. This study aimed to compare hemodynamic differences between BOT and transcatheter closure.MethodsA total of 42 patients with a single ASD over age 18 years who underwent BOT before transcatheter ASD closure between October 2010 and May 2020 were analyzed. Pulmonary capillary wedge pressure (PCWP) was measured using a Swan−Ganz catheter placed in the pulmonary artery at baseline, after 10 min of BOT, and after transcatheter closure. Amplatzer septal occluder was used for all transcatheter closures.ResultsMean patient age was 64 ± 18 years (range, 18−78). Mean ASD diameter and pulmonary to systemic flow ratio were 18 ± 5 and 2.8 ± 1.0 mm, respectively. Mean PCWP at baseline, during BOT, and after transcatheter closure was 8.9 ± 2.9, 13.5 ± 4.2, and 9.5 ± 2.6 mmHg, respectively. The difference between BOT and after transcatheter closure values was significant (p< 0.001). During BOT, PCWP increased ≥18 mmHg in 7 patients, whereas after ASD closure, PCWP was <18 mmHg in all 7 and none developed acute pulmonary edema.ConclusionTemporary balloon occlusion of an ASD and transcatheter ASD closure result in different hemodynamic change. BOT overestimates increase of PCWP after transcatheter ASD closure and requires careful interpretation. Well‐designed, larger studies in higher‐risk patients are warranted to verify the clinical implications of BOT in more detail.
登录
查看更多内容
继发孔房间隔缺损的装置闭合：根据球囊尺寸或不根据球囊尺寸
影响因子：
0.7
作者：
Z. Hijazi
通讯作者：
Z. Hijazi
影响因子：
2.3
作者：
Wu, En-Ting;Akagi, Teiji;Sano, Shunji
通讯作者：
Sano, Shunji
影响因子：
2.3
作者：
Miranda, William R.;Hagler, Donald J.;Taggart, Nathaniel W.
通讯作者：
Taggart, Nathaniel W.
影响因子：
2.3
作者：
Schubert, S;Peters, B;Ewert, P
通讯作者：
Ewert, P
影响因子：
2.3
作者：
Tomai, F;Andò, G;Chiariello, L
通讯作者：
Chiariello, L