Erişkinlerde sekundum atriyal septal defektlerin balon ölçümü yapılmadan perkütan yolla kapatılması: Üçüncü basamak bir merkezin deneyimi

Amaç: Bu çalışmada erişkinlerde sekundum atriyal septal defektlerin (ASD) perkütan yolla kapatılması işlemindeki klinik deneyimlerimiz ve erken dönem sonuçlarımızı değerlendirmeyi amaçladık.Yöntemler: Kliniğimizde Ocak 2010-Ekim 2012 tarihleri arasında sekundum ASD tanısı ile perkütan kapatma işlemi uygulanan 49’u kadın 22’si erkek toplam 71 hasta (ortalama yaşı 35±14 yıl) çalışmaya dâhil edildi. Hastalara sedoanaljezi eşliğinde ve balon ölçümü işlemi uygulanmadan perkütan ASD kapatma işlemi uygulandı. Hastaların klinik özellikleri, yapılan perkütan kapatma girişimlerinin özellikleri, gelişen komplikasyonlar ve erken dönem sonuçları değerlendirildi. Bulgular: Transözofageal ekokardiyografik incelemede hastaların ASD çapı 19,8±6,4 mm olarak ölçüldü. Bu hastalarda kullanılan kapatma cihazı çapı ortalaması 24,7±6,7 mm olarak saptandı. Toplam 71 hastadan 67’sinde (%94) işlem başarılı oldu. Dört hastada işlem başarısız olarak kabul edilerek cerrahi tedavi kararı alındı. İşlem sırasında bir hastada geçici 2. derece AV blok gelişirken başka bir hastada ise cihaz üzerinde trombüs gelişimi izlendi. Üç hastada birinci gün kontrollerinde rezidü ASD geçişi izlendi. Ortalama 13±8 ay (1-31) boyunca izlenen hastalarda rezidü geçiş, aritmi ve embolik komplikasyonlar izlenmedi. Sonuç: Perkütan ASD kapatma işlemi deneyimli merkezlerde yüksek başarı ve düşük komplikasyon oranları ile etkin ve güvenli bir tedavi yaklaşımıdır.

Percutaneous closure of atrial septal defects without balloon sizing in adults: Experience of a tertiary referral center

Objective: We aimed to evaluate our clinical experience and short-term results of percutaneous closure of secundum type atrial septal defects (ASD) in adults. Methods: We studied 71 patients (49 female, 22 male, mean age 35±14 years) undergoing percutaneous closure of ASD between January 2010-October 2012 in our clinic. All procedures were performed under sedoanalgesia without balloon sizing. Clinical characteristics of patients, properties of percutaneous closure intervention, complications and short-term results are evaluated. Results: Defect diameter measured by transesophageal echocardiographic examination was 19.8±6.4 mm. Device size used for percutaneous closure was 24.7±6.7 mm. Procedure was successfully performed in 67 patients (94%). Four patients were referred for surgery because of procedural failure. During procedure, a patient developed transient 2nd degree AV block, and another developed device thrombosis. Residual shunt was detected in three patients at first day control echocardiographic examination. In the follow-up of 13±8 months, no residual shunt, embolic or arrhythmic complications were observed. Conclusion: Percutaneous closure of secundum ASD is a safe and effective method with high success and low complication rates in experienced centers.

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