Device closure of secundum atrial septal defects: To balloon size or not to balloon size
Device closure of secundum atrial septal defects: To balloon size or not to balloon size
复制标题
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
DOI：
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发表时间：
2011
影响因子：
0.7
通讯作者：
Z. Hijazi
中科院分区：
文献类型：
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作者：
Z. Hijazi
伊利诺伊州芝加哥60612号电子邮件：zhijazi@rush.edu继发孔型房间隔缺损(ASD)约占所有形式先天性心脏病的10%。根据我们的经验，超过90%的继发孔型ASD应该可以接受设备关闭。闭合技术已经相当标准，在过去的30多年里没有太大的变化。通常，手术是在全身气管内麻醉下，经食道超声心动图(TEE)引导下完成的。在过去的10年里，我们一直在使用心内超声心动图(ICE)指导下进行清醒镇静下的手术。在血流动力学评估和超声心动图评估(TEE/ICE)之后，许多操作员进行球囊大小调整。球囊大小的旧技术是使用波士顿科学公司Meditech的圆形球囊，操作员在左心房充气球囊，在超声心动图和透视监测下，球囊以持续的温和牵引向房间隔收回，同时缓慢放气。一旦气球从左到右中庭弹出，操作员就会确定气球通过缺陷时内部的液体量，并使用该体积测量气囊体外的直径，或定格透视图像或回声图像，并在气球穿过缺陷时测量气球的大小。最近和过去10年里，研究人员一直在使用静止气球技术。气球在缺陷处充气，直到气球中出现“腰围”。拍摄电影透视图像或冻结回声图像并测量腰围。我们认为，这种技术大大高估了缺陷的大小，并可能在某些情况下导致侵蚀。因此，自2004年以来，我们一直使用“停流”技术，这种技术依赖于彩色多普勒超声心动图，而不是在气球中腰部。
Chicago, IL 60612. E-mail: Zhijazi@rush.edu Secundum atrial septal defect (ASD) constitutes about 10% of all forms of congenital heart disease. From our experience, over 90% of secundum ASDs should be amenable to device closure. The technique of closure has been fairly standard and has not changed much over the last 30 some years. Typically, the procedure is done under general endotracheal anesthesia with transesophageal echocardiographic (TEE) guidance. In the last 10 years, we have been doing the procedure under conscious sedation using intracardiac echocardiographic (ICE) guidance. After hemodynamic assessment and echocardiographic evaluation (TEE/ICE), many operators perform balloon sizing. The old technique of balloon sizing was using the circular balloon, from Meditech, Boston scientific where the operator inflates the balloon in the left atrium and under both echocardiographic and fluoroscopic monitoring, the balloon is withdrawn toward the atrial septum with constant gentle traction while deflating the balloon slowly. Once the balloon pops from left to right atrium, the operator determines the amount of fluid inside the balloon at the time of its passage through the defect and uses this volume to measure the balloon diameter outside the body, or frame freeze the fluoroscopy image or echo image and measure the size of the balloon when it traversed the defect. More recently and over the last 10 years, investigators have been using the stationary balloon technique. The balloon is inflated across the defect until “waisting” appears in the balloon. A cine fluoroscopy image is taken or the echo image is frozen and the waist is measured. This technique, we believe has over estimated the size of defect significantly and may have resulted in erosions in some of the cases. Therefore, since 2004, we have been using the “stop-flow” technique, which relies on color Doppler echocardiography rather than waisting in the balloon.[1]