Left ventricular conditioning in the elderly patient to prevent congestive heart failure after transcatheter closure of atrial septal defect
Left ventricular conditioning in the elderly patient to prevent congestive heart failure after transcatheter closure of atrial septal defect
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DOI：
10.1002/ccd.20292
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发表时间：
2005-03-01
影响因子：
2.3
通讯作者：
Ewert, P
中科院分区：
文献类型：
--
作者：
Schubert, S;Peters, B;Ewert, P
经导管封堵房间隔缺损是一种安全有效的治疗方法。在过去的几年里，越来越多的老年患者（年龄> 60岁）已经接受了经导管封堵术，以防止容量超负荷导致的持续充血性心力衰竭。然而，最近的数据表明，在一些患者中，外科手术或经导管ASD闭合后立即发生严重急性左心室功能障碍导致肺水肿的风险。在这项研究中，我们使用了之前描述的技术来提前识别ASD关闭后有左心衰风险的患者。然后，在进行确定性经导管ASD闭合术之前，对这些有风险的患者进行48-72小时的预防性预处理药物治疗。59例年龄在60岁以上（范围：60-81.8岁;中位数：68岁）的患者入住我们的机构，接受房间隔缺损的经导管封堵术。所有患者均在ASD临时球囊闭塞前和期间接受心房压力评估。ASD封堵术期间平均心房压升高（> 10 mm Hg）导致左心室受限的患者在使用Amplatzer间隔封堵器进行ASD封堵术之前，接受静脉注射多巴胺、米力农和呋塞米等抗充血调节药物48-72小时。在44例没有任何左心室限制迹象的患者中，在第一次治疗中进行了ASD闭合。59例患者中有15例（25%）出现左心室受限。在大多数左室收缩受限的患者中，ASD闭塞的平均左房压在预处理药物治疗48-72小时后显著降低。然后在第二次会议上进行了主动ASD关闭。只有2名患者接受了开孔型32 mm Amplatzer封堵器，因为即使在预处理药物治疗后，心房压力持续升高> 10 mm Hg。两组之间的分流、器械尺寸或缺损尺寸无显著差异。房间隔缺损球囊封堵术可识别ASD封堵术前左心室生理受限的患者。静脉抗充血调节药物似乎是非常有效的预防充血性心力衰竭介入关闭后的老年患者的房间隔缺损与限制性左心室。
Transcatheter closure of atrial septal defects (ASDs) is a safe and effective treatment. Over the past years, an increasing number of elderly patients (age > 60 years) have been admitted for transcatheter closure to prevent ongoing congestive heart failure from volume overload. However, recent data point to the risk of serious acute left ventricular dysfunction leading to pulmonary edema immediately after surgical or transcatheter ASD closure in some patients. In this study, we used a technique described before to recognize in advance patients at risk of left heart failure after ASD closure. Those patients at risk were then treated with preventive conditioning medication for 48-72 hr before definitive transcatheter ASD closure was performed. Fifty-nine patients aged over 60 years (range, 60-81.8 years; median, 68 years) were admitted to our institution for transcatheter closure of an atrial septal defect. All patients received evaluation of atrial pressures before and during temporary balloon occlusion of the ASD. Patients with left ventricular restriction due to increased mean atrial pressures (> 10 mm Hg) during ASD occlusion received anticongestive conditioning medication with i.v. dopamine, milrinone, and furosemide for 48-72 hr before definitive ASD closure with an Amplatzer septal occluder was performed. In 44 patients without any signs of left ventricular restriction, ASD closure was performed within the first session. Fifteen (25%) out of 59 patients showed left ventricular restriction. In the majority of patients with LV restriction, the mean left atrial pressures with occluded ASD were significantly decreased after 48-72 hr of conditioning medication. Definitive ASD closure was then performed in a second session. Only two patients received a fenestrated 32 mm Amplatzer occluder due to persistent increased atrial pressures > 10 mm Hg even after conditioning medication. There were no significant differences in shunt, device size, or defect size between the two groups. Balloon occlusion of atrial septal defects identifies patients with left ventricular restrictive physiology before ASD closure. Intravenous anticongestive conditioning medication seems to be highly effective in preventing congestive heart failure after interventional closure of an ASD in the elderly patient with a restrictive left ventricle.