Percutaneous closure of atrial septal defects without balloon sizing in adults: Experience of a tertiary referral center

Abstract

Objective: We aimed to evaluate our clinical experience and short-term results of percutaneous closure of secun­dum type atrial septal defects (ASD) in adults. Methods: We studied 71 patients (49 female, 22 male, mean age 35±14 years) undergoing percutaneous clo­sure of ASD between January 2010-October 2012 in our clinic. All procedures were performed under sedoanalge­sia without balloon sizing. Clinical characteristics of pa­tients, properties of percutaneous closure intervention, complications and short-term results are evaluated. Results: Defect diameter measured by transesophageal echocardiographic examination was 19.8±6.4 mm. De­vice size used for percutaneous closure was 24.7±6.7 mm. Procedure was successfully performed in 67 patients (94%). Four patients were referred for surgery because of procedural failure. During procedure, a patient developed transient 2nd degree AV block, and another developed device thrombosis. Residual shunt was detected in three patients at first day control echocardiographic examina­tion. In the follow-up of 13±8 months, no residual shunt, embolic or arrhythmic complications were observed. Conclusion: Percutaneous closure of secundum ASD is a safe and effective method with high success and low complication rates in experienced centers. J Clin Exp In­vest 2013; 4 (1): 67-72

Keywords

• Secundum atrial septal defect, percutaneous closure, sedoanalgesia, transesophageal echocardiogra­phy

Erişkinlerde sekundum atriyal septal defektlerin balon ölçümü yapılmadan perkütan yolla kapatılması: Üçüncü basamak bir merkezin deneyimi

Öz

Amaç: Bu çalışmada erişkinlerde sekundum atriyal sep­tal defektlerin (ASD) perkütan yolla kapatılması işlemin­deki klinik deneyimlerimiz ve erken dönem sonuçlarımızı değerlendirmeyi amaçladık. Yöntemler: Kliniğimizde Ocak 2010-Ekim 2012 tarihleri arasında sekundum ASD tanısı ile perkütan kapatma iş­lemi uygulanan 49\'u kadın 22\'si erkek toplam 71 hasta (ortalama yaşı 35±14 yıl) çalışmaya dâhil edildi. Hastala­ra sedoanaljezi eşliğinde ve balon ölçümü işlemi uygulan­madan perkütan ASD kapatma işlemi uygulandı. Hasta­ların klinik özellikleri, yapılan perkütan kapatma girişimle­rinin özellikleri, gelişen komplikasyonlar ve erken dönem sonuçları değerlendirildi. Bulgular: Transözofageal ekokardiyografik inceleme­de hastaların ASD çapı 19,8±6,4 mm olarak ölçüldü. Bu hastalarda kullanılan kapatma cihazı çapı ortalama­sı 24,7±6,7 mm olarak saptandı. Toplam 71 hastadan 67\'sinde (%94) işlem başarılı oldu. Dört hastada işlem başarısız olarak kabul edilerek cerrahi tedavi kararı alın­dı. İşlem sırasında bir hastada geçici 2. derece AV blok gelişirken başka bir hastada ise cihaz üzerinde trombüs gelişimi izlendi. Üç hastada birinci gün kontrollerinde rezi­dü ASD geçişi izlendi. Ortalama 13±8 ay (1-31) boyunca izlenen hastalarda rezidü geçiş, aritmi ve embolik kompli­kasyonlar izlenmedi. Sonuç: Perkütan ASD kapatma işlemi deneyimli merkez­lerde yüksek başarı ve düşük komplikasyon oranları ile etkin ve güvenli bir tedavi yaklaşımıdır.

Anahtar Kelimeler

• Sekundum atriyal septal defekt, per­kütan kapatma, sedoanaljezi, transözofageal ekokardi­yografi

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