FOLLOW-UP IN CLOSING OF ATRIAL SEPTAL DEFECT BY CATHETERISM WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) GUIDANCE

Autor: S. De Dios Ana Maria, B. Zarlenga, E. Kreutzer., E. Flores, V. Orence., E. Fischman, L. Trentacoste, J. Damsky Barbosa, Judith Ackerman, M. Granja
Rok vydání: 2004
Předmět:
Zdroj: Echocardiography. 21:213-213
ISSN: 1540-8175
0742-2822
Popis: Background: Follow-up in closing atrial septal defects (ASD) by transcatheter device, with TEE guidance. Methodology: In 137 patients with ASD ostium secundum (os) the mean (X) age of the patients was 8.78 years (range from 2 to 50 years). 120 patients with isolated defects, 12 with other small ASDs, 2 with fenestrated ASDs (fASD),1 patients had patent ductus arteriosus, 2 had ventricular Septal Defects (VSD). Following a routine hemodynamic evaluation in the catheter laboratory a TEE was conducted to measure in millimeters the location and size of the defect, as well as the distance from the defect to the upper pulmonary vein (upv), the tricuspid (TV) and mitral (MV) valves, and the superior (SVC) and inferior (IVC) cava veins. The residual shunt as well as complications were evaluated. Statistical Analysis: Statistical significance p < 0.05. Results: The ASD measured by TEE in short axis: X: 14.4 ± 4.53 mm (range: 7.4 ± 32), in 4-chamber view: X: 14.77 ± 5 mm (range: 6.5–33), in sagittal, at level of cava veins: X: 17.49 ± 10,29 mm (range: 6.5–38); balloon sizing: 18.3 ± 5.39 mm (range: 10–38); mean size of the device: 18.11 ± 5.57 mm (range 10–38). The distance from the upper edge to the upper pulmonary vein (upv): X: 9.11 ± 2.44 mm (range: 5.3–15); to tricuspid valve (T.V): X: 13.35 ± 3.17 mm (range: 6.5–19), mitral valve (M.V): X: 11.26 ± 2.36 (range: 7–14.4), left superior vena cava (SVC): X: 11.21 ± 2.83 mm (range: 6.2–16.9) and inferior vena cava (IVC): X: 10.21 ± 3.12 mm (range: 7–17.7). The Qp/Qs: 1.97 ± 0.45 (range: 1.25–3.5), pressure in RA: 5.79 ± 3 mmhg (range: 2–12), in LA: 7.42 ± 3.19 mmhg (range: 2–12); in RV: 33.82 ± 6.73 mmhg (24–50) and in pulmonary artery: 29.5 ± 5.92 mmhg (range 20–60), the wedge pressure X: 13.76 ± 3.92 mmhg (range: 9–25). The closure was effective in 137 of 134 cases (97.8 %); there were three embolizations: two defects with size in upper limit, and 1 accidental. These three were operated and the device was recovered, 1 died at 48 hours post-surgery. Residual shunts were found in 16 patients: 12 trivial, 4 light. Four remained permeable to another small ASD (3mm); 1patient had progressive mitral regurgitation and required mitral replacement. Ten patients had arrhythmia (2 with complete branch block, 2 with second degree block, 3 with supraventricular arrythmia, and 1 with sinusal tachycardia). Conclusion: Closure with the Amplatzer device was an effective procedure in 97.8% of the cases (137/134). During the procedure dangerous complications could take place (3 embolizations). The arrhythmias were not frequently in later evolution (10/137). Mortality was 0.72%. We still require further experience to be able to determine which procedure is best in each case.
Databáze: OpenAIRE
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