Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study.

IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Pediatric Cardiology Pub Date : 2023-11-01 Epub Date: 2024-04-23 DOI:10.4103/apc.apc_163_23
Jahangir Ahmed Naseem, Mirza Shohiab Ur Riyaz, Shobhit Priyanshu Joseph, Jesu Krupa, Mayank Agarwal, Pratheesh George Mathen, Oommen K George, Paul V George, John Jose, Viji Samuel Thomson
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引用次数: 0

Abstract

Background: In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure.

Methods: We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up.

Results: We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4-7) years and median (IQR) weight of 14 (12-18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%- I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt.

Conclusion: In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.

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经导管关闭有症状小儿的巨大房间隔缺损:单中心回顾性研究。
背景:一般来说,经导管房间隔缺损(ASD)装置闭合术的相关风险相对较低,但这些证据均来自涉及成人和年长儿童的试验。目前的指南不建议对缺损尺寸大于 20 毫米的儿童进行 ASD 装置闭合,因为这类患者的可用数据有限。这项回顾性研究旨在确定有大面积缺损的幼童成功经导管 ASD 装置闭合的临床和程序特征,并评估并发症发生率和装置闭合不成功的原因:我们回顾性地回顾了2013年9月至2022年2月期间在我科接受择期经导管闭合ostium secundum ASD的所有患者的数据。所有患儿均进行了称重:我们确定了 40 名符合纳入标准的患者,其手术年龄中位数(四分位数间距 [IQR])为 5(4-7)岁,体重中位数(IQR)为 14(12-18)公斤。39名患者成功完成了装置闭合,成功率为97.5%。总并发症发生率为 2.5%(95% 置信区间:0.44%- I2.8%),仅有 1 例重大并发症。所有患儿均有右心扩大和劳力性呼吸困难,30%的患儿反复出现下呼吸道感染,10%的患儿发育不良。随访1年后,经胸超声心动图显示所有患者的分流装置内皮都已完全愈合,位置稳定,没有一名患者有残余分流:结论:在经验丰富的医疗中心,经皮ASD闭合术可以有效、安全地为无症状的幼儿进行大面积缺损闭合,而且具有很高的可预测性和较低的并发症发生率。
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来源期刊
Annals of Pediatric Cardiology
Annals of Pediatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.40
自引率
14.30%
发文量
51
审稿时长
23 weeks
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