Oktay ERGENE, Cem NAZLI, Uğur KOCABAŞ, Hamza DUYGU, Nihan Kahya EREN, Zehra İlke AKYILDIZ, Ali Hikmet KIRDÖK, Rida BERİLGEN

Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

Amaç: Bu çalışmada, kliniğimizde perkütan yolla atrial septal defekt (ASD) kapatılması işlemi uygulanan hastalara ait klinik deneyimimizin ve sonuçlarının değerlendirilmesi amaçlanmıştır. Bulgular: Çalışmaya kliniğimizde, Mart 2008-Ocak 2010 tarihleri arasında perkütan yolla ASD kapatılması işlemi uy-gulanan ortalama yaşı 36±14,8 olan (17-75) yıl olan 70 hasta (19 erkek, 51 kadın) retrospektif olarak alındı. Hastala-rın transözofajial ekokardiyografi ölçümlerinde ASD çapı 19,7±6,3 mm (6-32 mm) olarak ölçüldü. Perkütan kapatma-da kullanılan cihaz çapları 23,7±6,2 (12-36) olarak saptandı. ASD kapatma cihazı olarak nitinol bazlı cihazlardan Amplatzer %64,7, Cardiofix %26,7 oranında ve biodegredable BioStar %8,6 oranında kullanıldı. Yetmiş hastadan 68\'inde (%97) işlem başarılı oldu. Bir hastada işlem esnasında cihaz embolisi, 1 hastada ise cihazda strut kırığı ol-ması nedeniyle hastalar cerrahiye verildi. Takipte 2 hastada 1. gün kontrolünde cihaz embolizasyonu saptandı. Üç hastada (%4,2) kardiyoversiyon ile sinus ritmine çevrilen supraventriküler aritmi izlendi. Hastalar ortalama 18,6±9,6 ay (1 ay- 44 ay) boyunca izlendi. Takipte hastalarda cihaz üzerinde thrombüs, cihaz erozyonu, periferik vasküler komplikasyon, serebro vasküler olay veya ölüm izlenmedi. Sonuç: Sekundum ASD\'lerin perkütan kapatılması son yıllarda cerrahinin yerini almaya başlayan kısa ve orta vadede güvenli, etkin bir tedavi şeklidir. İşlemin potansiyel ciddi olabilecek komplikasyonları nedeniyle yapısal kalp hastalıkla-rının tedavisinde uzmanlaşmış; tecrübeli merkezlerde yapılması hususuna dikkat edilmelidir.

Anahtar Kelimeler:

Atrial septal defekt, perkütan kapatma, klinik sonuçlar

Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

Objectives: This study was aimed to evaluate our clinical experiences and investigate results of percutaneous clo-sure of secundum atrial septal defects (ASD) in our clinic. Results: We retrospectively included 70 patients (19 male, 51 female) undergoing percutaneous ASD closure proce-dure with mean age of 36±14.8 (17-75) in our clinic between March 2008 and January 2010. Defect diameter meas-ured by transesophageal echocardiography was 19.7±6.3 mm (6-32 mm). Device size used for percutaneous closure of ASD was 23.7±6.2 (12-36). Devices used for percutaneous closure were nitinol-based devices including Amplatzer (64.7%), Cardiofix (26.7%) and biodegredable BioStar (8.6%). The percutaneous closure procedure was successful at 68 of 70 (97%) patients. In 2 patients procedure failed. Failure reason was device embolization in one patient and device strut fracture in other; so these 2 patients referred to surgery. During follow up 2 more patients also referred to surgery because of device embolization in first day control. In 3 patients (4.2%) supraventricular arrythmias that are converted to sinus by cardioversion are observed. Mean follow up interval was 18.6±9.6 months (1-44) and during this period peripheral vascular complications, cerebrovascular accidents, thrombus on devices, device erosion or death is not observed. Conclusion: Percutaneous closure of secundum ASD which started to replace surgical treatment of ASD in last dec-ades is safe and effective method in short to mid-term period. However because of potentially serious complication risks it should be performed in special centers by operators who are experienced in treating structural heart diseases.

Keywords:

Atrial septal defect, percutaneous closure, clinical outcome,

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