Single Centre Experience For Percutaneous Closure Of Secundum Atrial Septal Defect

Öz

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

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

• Ali Rıza Akyüz

Kaynakça

1. 1. Child J, Perloff J. Natural survival patterns: A narrowing Base. Congenital Heart Disease in Adults. 1st ed. Philadelphia: WB Saunders; 1991. p.21.
2. 2. Borrow K, Braunwald E. Congenital heart disease in adults. Heart Disease. 1st ed. Philadelphia: WB Saunders; 1988. p. 976.
3. 3. Allen HD, Beekman RH 3rd, Garson A Jr, et al. Pediatric therapeutic cardiac catheterization: A statement for healthcare professionals from the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1998;97:609-25.
4. 4. Veldtman GR, Razack V, Siu S, El-Hajj H, Walker F, Webb GD, et al. Right ventricular form and function after percutaneous atrial septal defect device closure. J Am Coll Cardiol 2001:15;37(8):2108-13.
5. 5. Warnes CA. Adult Congenital Heart Disease. In: Murphy JG, Lloyd MA eds. Mayo Clinic Cardiology, Concise Textbook. 3rd ed. Canada: Informa Healtcare; 2008;965-76.
6. 6. Pihkala J, Nykanen D, Freedom RM, Benson LN. Interventional cardiac catheterization. Pediatr Clin North Am 1999;46:441-64.
7. 7. Pastorek JS, Allen HD, Davids T. Current outcomes of surgical closure of secundum atrial septal defect. Am J Cardiol 1994;74:75-7.
8. 8. Fischer G, Stieh J, Uebing A, Hoffmann U, Morf G, Kramer HH. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart 2003;89:199- 204.

9. 9. Omeish A, Hijazi ZM. Transcatheter closure of atrial septal defects in children and adults using the Amplatzer Septal Occluder. J Interv Cardiol 2001;14:37-44.
10. 10. Dhillon R, Thanopoulos B, Tsaousis G, Triposkiadis F, Kyriakidis M, Redington A. Transcatheter closure of atrial septal defects in adults with the Amplatzer septal occluder. Heart 1999;82:559-62.
11. 11. Fischer G, Kramer HH, Stieh J, Harding P, Jung O. Transcatheter closure of secundum atrial septal defects with the new self-centering Amplatzer Septal Occluder. Eur Heart J 1999;20:541-9.
12. 12. Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K. Amplatzer Investigators Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 2002 5;39:1836-44.
13. 13. Suárez De Lezo J, Medina A, Pan M, Romero M, Segura J, Pavlovic D, et al. Transcatheter occlusion of complex atrial septal defects. Catheter Cardiovasc Interv 2000 Sep;51:33-41.
14. 14. Zaqout M, Suys B, De Wilde H, De Wolf D. Transthoracic echocardiography guidance of transcatheter atrial septal defect closure in children. Pediatr Cardiol 2009;30:992-4. 15. Sahin M, Ozkutlu S, Yıldırım I, Karagöz T, Celiker A. Transcatheter closure of atrial septal defects with transthoracic echocardiography. Cardiol Young 2010; 22:1-5.
15. 16. Ilkay E, Kaçmaz F, Ozeke O, Turan RS, Firat S, Pampal K, et al. The efficiency and safety of percutaneous closure of secundum atrial septal defects with the Occlutech Figulla device: initial clinical experience. Turk Kardiyol Dern Ars. 2010;38:189-93.
16. 17. Wang JK, Tsai SK, Wu MH, Lin MT, Lue HC. Short- and intermediate-term results of transcatheter closure of atrial septal defect with the Amplatzer Septal Occluder. Am Heart J. 2004;148:511-7.
17. 18. Chessa M, Carminati M, Butera G, Bini RM, Drago M, Rosti L, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol 2002;39:1061-5.
18. 19. Çeliker A. Atriyal ve ventriküler septal defektlerde girişimsel tedavi: Hasta seçimi, işlem ve komplikasyonlar. Türkiye Klinikleri Kardiyoloji. 2008;1:43-57