Author/Editor     Mazić, Uroš; Berden, Pavle; Podnar, Tomaž
Title     Percutaneous closture of secundum-type atrial septal defects using Amplatzer septal occliders
Translated title     Perkutano zapiranje defektov interatrijskega septuma tipa sekundum z Amplatzovimi septalnimi zapirali
Type     članek
Source     Zdrav Vestn
Vol. and No.     Letnik 72, št. 1
Publication year     2003
Volume     str. 1-6
Language     eng
Abstract     Background. Percutaneous closure of secundum type atrial septal defect (ASD II) is becoming an increasingly widespread alternative to surgical closure. We report our initial clinical experience with the percutaneous closure of ASD ll. using Amplatzer Septal Occluders (ASO) in Slovenia. Patients and methods. Fifty consecutive patients with ASD II. were evaluated for transcatheter closure with ASO using both transthoracic (TTE) and transesophageal echocardiography (TEE). Transcatheter closure was performed under general endotracheal anesthesia with simultaneous fluoroscopy and TEE guidance. The stretch defect diameter was measured using an Amplatzer sizing balloon catheter The ASO having a 2-4 mm larger diameter than the stretched defect diameter was selected for defect closure. Follow-up was scheduled 10 min, 24 hours, 1 month, 3 months, 6 months, 1 year and then annually after the procedure. Results. Eight patients (10%) with deficiency of the posterior, inferior anterior, or inferior posterior rim were not deemed suitable for transcatheter closure and were referred for surgery. Fourteen patients (28%) had centrally positioned defects, 23 patients (46%) defects with a deficient superior anterior rim, 3 patients had multiple defects, while 2 patients presented with atrial septal aneurysm: 1 associated with a single perforation and 1 with multiple perforations. So far, cardiac catheterization has been performed in 24 patients, while the remaining 12 patients are waiting cardiac catheterization. During cardiac catheterization, 1 additional patient was excluded from percutaneous closure due to an additional defect unsuitable for percutaneous closure. (Abstract truncated at 2000 characters).
Summary     Izhodišča. Defekt interatrijskega septuma tipa sekundum (ASD II) je ena najpogostejših prirojenih srčnih napak. Klasično zdravljenje ASD II je kirurško. Od leta 1974 dalje je bila preizkušana vrsta različnih tipov zapiral za perkutano zapiranje ASD II. Pri vseh zapiralih so bile ugotovljene pomembne pomanjkljivosti, zato se nobeno od zapiral ni uveljavilo v klinični praksi. Najpogosteje ugotovljene pomanjkljivosti zapiral so bile: zapleteni postopki vstavljanja zapiral, številni zapleti med in po posegu vključno s poznimi embolizacijami zapiral, zlomi oz. mehanskimi poškodbami zapiral ter visok delež rezidualnih šantov. Leta 1995 je bilo prvič klinično uporabljeno Amplatzovo septalno zapiralo (ASZ). Zapiralo je bilo zasnovano z namenom, da preseže pomanjkljivosti predhodnih zapiral in tako izboljša rezultate perkutanega zapiranja. V članku smo predstavili prve klinične izkušnje s perkutanim zapiranjem ASD II z uporabo Amplatzovega septalnega zapirala v Sloveniji. Metode. V prospektivno študijo smo vključili 50 zaporednih bolnikov z ASD II. Pri vseh bolnikih smo opravili transtorakalni TE) in transezofagealni (TEE) ehokardiogram. Za perkutano zapiranje smo izbrali bolnike, ki so izpolnjevali naslednje kriterije: 1. s TEE izmerjen največji premer defekta < 30 mm; 2. dolžina robov defekta >5 mm, razen zgornjega sprednjega roba; 3. interatrijski septum daljši od premera levega diska ASZ. Perkutano zapiranje smo pri vseh bolnikih izvedli v splošni anesteziji s sočasnim diaskopskim in TEE nadzorom. Zapiralo smo vstavili preko desne femoralne vene. Velikost zapirala smo izbrali na osnovi meritve razteznega premera defekta. Meritev smo izvedli z Amplatzovim merilnim balonskim katetrom. Za zapiranje smo izbrali 2-4 mm večje zapiralo od izmerjenega razteznega premera defekta. (Izvleček skrajšan pri 2000 znakih).
Descriptors     HEART SEPTAL DEFECTS, ATRIAL
HEART CATHETERIZATION
IMPLANTS, ARTIFICIAL
ECHOCARDIOGRAPHY
PATIENT SELECTION
PROSPECTIVE STUDIES