Single Centre Experience For Percutaneous Closure Of Secundum Atrial Septal Defect

Abstract

Introduction: Atrial septal defect (ASD) is the most common congenital heart disease in adults and constitutes 5-10% of all congenital heart disease. Primary surgical closure has been the standard approach for many years with high success rate. Transcatheter closure of ASD in selected patients has became the contemprorary practice that has the advantages of short hospital stay and relative ease of prosedure. In this article, we reported the results of percutaneous closure of ASD in our center. Methods: Between 2009-2011, thirty-two patients (mean age 36±18 years and 24 females) who had secundum type ASD which detected by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were included in this study. Twenty-nine (90,6%) patients were closed percutaneously. Tree patients were referred for surgery because of failure of percutaneous closure. Amplatzer Septal Occluder was used in 25 (86,2%) patients and Occlutech device was used in other patients. All procedures were performed under local anesthesia. All of the patients were examined with TTE before the procedure and, at the 1st, 3rd, 6th and 12th month follow-up visits. Results: Pre-operative mean pulmonary artery pressure was 33,3±7,5 mmHg and mean pulmonary to systemic flow (Qp/Qs) ratio was 2,9±1,1. Mean ASD diameter measured by TEE was 20,1±6,6 mm and mean streched diameter measured by balloon catheter was 22,1±5,9 mm. Mean device size 24±6 mm (range 12-36 mm). In the follow-up period no major complication was observed, but mild to moderate residual shunt flow was detected in two patients (% 6,8). Conclusion: Percutaneous ASD closure has been performed with high success and low complication rates in patients with secundum atrial septal defect in our center

Keywords

• Secundum ASD, percutaneus closure, transthoracic echocardiography, transesophageal echocardiography

Sekundum Tipi Atriyal Septal Defekt'de Tek Merkez Perkütan Kapama Sonuçlarımız

Abstract

Giriş: Atriyal septal defekt (ASD), erişkinlerdeki en sık doğuştan kalp hastalığıdır ve tüm doğuştan kalp hastalıklarının % 5-10' unu oluşturmaktadır. Cerrahi tedavi yüksek başarı oranı ile uzun zamandır standart tedavi metodu olarak kullanılmıştır. Uygun vakalarda, günümüzün popüler tedavi yöntemi perkütan ASD kapamadır. Bu yöntem görece işlem kolaylığı ve nekahat süresinin kısalığı gibi avantajlar sağlamaktadır. Bu makalede, merkezimizde yapılan perkütan ASD kapama sonuçları bildirildi. Metod: Bu çalışmaya, 2009-2011 yılları arasında transtorasik ekokardiyografi (TTE) ve transözofajiyel ekokardiyografi (TÖE) aracılığı ile tespit edilen sekundum tipi ASD'li 24'ü kadın 32 hasta (ortalama yaş; 36±18 yıl) dahil edildi. 29 hastada ASD (% 90,6) perkütan yolla kapatılırken; 3 hasta işlem başarısızlığı nedeni ile cerrahiye yönlendirildi. 25 olguda (% 86,2) Amplatzer Septal Occluder cihazı kullanılırken; diğer olgularda Occlutech cihazı kullanıldı. Tüm hastalarda işlem lokal anestezi altında yapıldı. Perkütan kapama yapılan hastaların tümü işlem öncesi ve işlemden 1, 3, 6 ve 12 ay sonra TTE ile takip edildi. Bulgular: Olgularımızda, işlem öncesi ortalama pulmoner arter sistolik basınçları 33,3±7,5 mmHg ve pulmoner/sistemik kan akım oranı (Qp/Qs) 2,9±1,1 idi. TÖE ile ölçülen ortalama ASD çapı 20,1±6,6mm, balon kateter ile ölçülen ortalama gerilmiş çap 22,1±5,9 mm idi. Ortalama cihaz boyutu 24±6 mm (12-36 mm arası) idi. Takipte, herhangi bir major komplikasyon izlenmezken; 2 (%6,8) hastada hafif-orta düzeyde rezidüel kaçak saptandı. Sonuç: Merkezimizde, sekundum tipi ASD' li hastalarda, perkutan ASD kapama yöntemi yüksek başarı ve düşük komplikasyon oranları ile uygulanabilmektedir. Anahtar Kelimeler: Sekundum ASD, perkütan kapama, transtorasik ekokardiyografi, transözofajiyel ekokardiyografi.

Keywords

• Ali Rıza Akyüz

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