Trans-catheter closure of atrial septal defect: Balloon sizing or no Balloon sizing - single centre experience.
Trans-catheter closure of atrial septal defect: Balloon sizing or no Balloon sizing - single centre experience.
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DOI：
10.4103/0974-2069.79619
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发表时间：
2011-01
影响因子：
0.7
通讯作者：
Ajit K
中科院分区：
文献类型：
--
作者：
Gupta SK;Sivasankaran S;Bijulal S;Tharakan JM;Harikrishnan S;Ajit K
对于边缘松软的继发孔型房间隔缺损(OSASD)，使用球囊选择装置尺寸可能过大，有时可能导致并发症。使用经食道超声心动图(TEE)确定稳固的边缘并选择合适大小的装置可优化ASD装置的关闭。这项回顾研究是为了记录不需要球囊确定缺陷大小的情况下关闭装置的安全性和可行性。将61例在球囊定位和术中透视引导下进行OSASD封堵术的患者(I组)与67例在设备部署过程中使用TEE进行缺陷大小测定和术中成像的连续患者(II组)进行比较。比较两组的手术成功率、器械特点和并发症。手术成功率为79.7%。II组成功率(60/67，89.6%)明显高于I组(41/61，67.2%)(P=0.002)。第二组ASD器械的平均尺寸显著降低(P<；0.001)。在患有较大ASD(25 Mm)的受试者和14岁以下的受试者中，TEE使用较小的装置也提供了更好的成功率。有4例装置栓塞术(每组2例)；其中1例在II组中死亡，尽管手术成功。气囊大小可能不是ASD成功关闭的关键。TEE指导的ASD规模调整和设备部署使用相对较小的设备可提供更高的成功率。
Selecting the device size using a sizing balloon could oversize the ostium secundum atrial septal defect (OSASD) with floppy margins and at times may lead to complications. Identifying the firm margins using trans-esophageal echocardiography (TEE) and selecting appropriate-sized device optimizes ASD device closure. This retrospective study was undertaken to document the safety and feasibility of device closure without balloon sizing the defect. Sixty-one consecutive patients who underwent trans-catheter closure of OSASD guided by balloon sizing of the defect and intra procedural fluoroscopy (group I) and 67 consecutive patients in whom TEE was used for defect sizing and as intraprocedural imaging during device deployment (group II) were compared. The procedural success rate, device characteristics, and complications were compared between the two groups. The procedure was successful in 79.7 % patients. The success rate in group II (60 of 67, 89.6%) was significantly higher than in group I (41 of 61, 67.2 %) (P = 0.002). Mean upsizing of ASD device was significantly lower in group II (P < 0.001). TEE also provided better success rate with smaller device in subjects with large ASD (>25 mm) and in those who were younger than 14 years of age. There were four cases of device embolization (two in each group); of which one died in group II despite successful surgical retrieval. Balloon sizing may not be essential for successful ASD device closure. TEE-guided sizing of ASD and device deployment provides better success rate with relatively smaller sized device.