POLİVİNİL ALKOL MEMBRANININ SPONTAN PERFORASYONU: ATRİYAL SEPTAL DEFEKT KAPAMA CİHAZI DİSFONKSİYONUNUN NADİR BİR NEDENİ

Amaç: Atriyal septal defektin perkütan yolla kapatılması etkinliği kanıtlanmış bir prosedür olup birçok avantajı nedeniyle standart tedavi haline gelmiştir. Bununla birlikte, polivinil alkol membran ile kaplanmış Atriyal septal defektin kapama cihazları, spontan Polivinil Alkol membran perforasyonuna bağlı olarak tekrarlayan ciddi şantlara neden olabilir. Çalışmamızda, Polivinil Alkol membran ile kaplı CARDIA Ultrasept Atriyal septal defektin kapama cihazı (Eagan, Minnesota, ABD) implante edilen hastalarımızda, spontan polivinil alkol membran perforasyonu gelişip gelişmediğini araştırmayı amaçladık. Yöntem: CARDIA Ultrasept protezi ile perkütan kapama uygulanan sekundum tip Atriyal septal defektin tanılı tüm hastalarımızı retrospektif olarak gözden geçirdik. Bulgular: UItrasept cihazı ile atriyal septal defektin kapama işlemi uygulanan, 4 ila 56 yaşları arasında olan on hasta çalışmaya alındı. Medyan 26 aylık takip periyodu sırasında, dört hastada polivinil alkol membran sorunu saptandı. Üç hastada polivinil alkol membran perforasyonu tekrar girişim gerektiren ciddi soldan sağa şanta neden olurken, bir hastada minimal rezidü şanta neden oldu. Kullanılan cihazlar 14 mm (iki hasta), 16 mm (bir hasta) ve 30 mm (bir hasta) idi. İki hastada, sorunlu cihazın cerrahi olarak çıkarılması ve perikardiyal yama ile kapama işlemi uygulandı. Bir hastada ise perkütan ikinci atriyal septal defektin cihazı ile kapama işlemi uygulandı. İkinci prosedürler sonrası, bu üç hastada da rezidü şant tespit edilmedi. Sonuç: Polivinil alkol membran perforasyonu nadir görülür ve genellikle yeniden girişim gerektirir. Operatörler bu sorunun farkında olmalı ve polivinil alkol membran kaplı cihaz implante edilen tüm hastalarını tekrar gözden geçirmelidirler.

SPONTANEOUS PERFORATION OF POLYVINYL ALCOHOL MEMBRANE: A RARE CAUSE OF ATRIAL SEPTAL OCCLUDER FAILURE

Objective: Percutaneous closure of atrial septal defect is a well-established procedure and has evolved to become the standard of care due to its manyadvantages. However, atrial septal defect closure devices covered with polyvinyl alcohol membrane could cause recurrent significant shunts due to aspontaneous polyvinyl alcohol membrane perforation. To investigate whether spontaneous polyvinyl alcohol membrane perforation developed in ourpatients who had implanted with CARDIA Ultrasept atrial septal defect occluder (Eagan, Minnesota, USA) that covered with Polyvinyl Alcoholmembrane.Methods: We retrospectively rewieved all patients with a diagnosis of secundum type atrial septal defect who underwent percutanoues closure withCARDIA Ultrasept prosthesis.Results: Ten patients aged 4 to 56 years who underwent atrial septal defect closure with UItrasept device were included. During a median 26 monthsfollow up period, we detected a four cases of polyvinyl alcohol membrane failure. In 3 patients, perforation of polyvinyl alcohol membrane causedsignificant left to right shunt that required re-intervention, while in one patient it caused minimal residual shunt. The devices were used were 14 mm(two patients), 16 mm (one patient) and 30 mm (one patient). Two patients underwent surgical device removal and pericardial patch closure. Onepatient underwent device in device procedure. Residual shunts were not occured in after reinterventions.Conclusion: Polyvinyl alcohol membrane perforation is rare and can require reintervention. Operators have to be aware of this malfunction.

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