四十歲以上的心房中隔缺損病人心導管關閉與開刀兩種治療方法追蹤結果之比較

To present the short-and mid-term
results of transcatheter closure of atrial
septal defect (ASD) in patients older
than 40 years.
Between January 1998 and September
2005, transcatheter closure of ASD was
attempted in 86 patients (18 males)
above 40 years of age (aged ranging
from 40 to 81 years, median 51). All
except 2 patients were symptomatic.
Deployment of device was performed
under general anesthesia and
transesophageal echocardiographic
monitoring. The results of transcatheter
closure were compared with those of
surgery in the past 10 years.
Of the 86 patients, Enlargement of
right ventricle was documented on the
echocardiography in 83. Atrial
arrhythmia was present in 11 patients.
Patients with atrial arrhythmia was
significantly older than those without.
(64 ± 9 vs. 52 ± 7 years, P < 0.01) The
mean Qp/Qs ratio was 3.11 ± 0.99
(ranging from 1.5 to 6.4). The mean
stretched diameter of the defect was 23
± 6.8 mm. (ranging from 11 to 35 mm)
Thirteen patients had multiple defects.
Pulmonary hypertension was present in
50 patients. The procedure was
successful in all 86 patients. Amplatzer
septal occluder (ASO) was used in 84
patients, CardioSeal device in 1 and
Buttoned device in remaining 1. Six
underwent ASD closure with a
fenestrated device because of presence
of significant heart failure. Five
underwent implantation using 2 ASO
devices. During the procedure, 2
experienced supraventricular
tachycardia which was treated with
cardioversion. One complicated with
tamponade requiring drainage. One had
a distal embolism to a finger tip 2 days
after the procedure. The mean follow-up
period is 2.9 ± 1.4 years. Four had
small residual shunt in the latest
follow-up of whom 2 had multiple
defects. Pulmonary hypertension and
right ventricular enlargement persisted
in 1 and 4 patients respectively, in the
latest echocardiographic follow-up.
Symptomatic improvement was
documented in all except 1. Of the 11
patients with atrial arrhythmias, 6
patients recovered to sinus rhythm and 5
had persisted atrial arrhythmias in the
latest follow-up. Two had new onset
atrial arrhythmia 3-months following the
procedure. In the past 10 years, surgery
for ASD was performed in 49 patients.
Eleven of them developed
post-operative pericardial effusion. (1/86
vs. 11/49, P ‹0.001 ). Eight patients had
significant arrhythmia.
4
Transcatheter closure of ASD in
patients above 40 years of age is safe
and effective where patients may benefit
from the procedure. Surgery carries a
higher risk of postoperative pericardial
effusion than transcatheter closure.
Abbreviations:
Atrial septal defect (ASD)
Transesophageal echocardiography
(TEE)