Mustafa BULUT, Rezzan Deniz ACAR, Müslüm ŞAHİN, Mehmet Fatih YILMAZ, Burak ÖZTÜRKERİ, Mustafa YILDIZ

Percutaneous treatment of septal defects; A single-center experience

Giriş: Atriyal septal defekt (ASD), erişkinlerde en sık görülen konjenital kardiyak anomalidir. Bu çalışmanın amacı, kendi deneyimimize dayanarak perkütan yöntemlerle ASD ve patent foramen ovale (PFO) kapatılan hastaların işlem başarısı ve erken dönem sonuçlarını değerlendirmektir. Hastalar ve Yöntem: Perkütan girişim yapılmış ASD ve PFO hastaları retrospektif olarak değerlendirilmiştir. Minör ve majör komplikasyon oranları, işlem başarısı ve erken dönem sonuçları değerlendirilmeye alınmıştır. Bulgular: İşlem başarısı %96,9 olarak değerlendirilmiştir. Minör komplikasyon oranı %2,7 olarak ölçülmüştür. Majör komplikasyon veya hastane içi ölüm görülmemiştir. Septal defektlerin kapatılması sonrası sol atriyum bolümü ve pulmoner arter basıncı anlamlı olarak düşmüştür. Perkütan girişimle ASD kapatılmış olan iki hastada rezidüel şant tespit edilmiştir. Bir hastada minimal perikardiyal efüzyon ve bir hastada da işlem sonrası hafif ateş tespit edilmiştir. Sonuç: Uygun hastalarda septal defektlerin perkütan yolla kapatılması, kısa dönem sonuçları ve komplikasyon oranları değerlendirildiğinde, etkili ve güvenilir bir yöntemdir.

Septal defektlerin perkütan yolla kapatılması; Tek merkez deneyimi

Introduction: Atrial septal defect (ASD) is the most common congenital anomaly in adults. The aim of this study was to assess the operation success of percutaneous closure of ASD and patent foramen ovale (PFO) and the short-term results based on our experience. Patients and Methods: Patients with ASD and PFO in whom percutaneous intervention was performed were evaluated retrospectively. Minor and major complication rates, success rate and short-term outcomes of the procedure were assessed. Results: The overall success rate of the procedure was 96.9%. The minor complication rate was 2.7%. There were no major complication and in-hospital deaths. Left atrium volume and pulmonary artery pressure were decreased significantly after the closure of the septal defects. Two patient in whom percutaneous ASD closure was performed had a residual shunt. One patient developed minimal pericardial effusion and one had mild fever following the procedure. Conclusion: The results of our series confirm that percutaneous closure of septal defects is an effective and safe technique according to the short term results and complication rates when it is performed in selected patients.

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1. Centers for Disease Control. Birth Defects. Available at: http:// www.cdc. gov/ncbddd/birthdefects/data.html. Accessed December 4, 2012.
2. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;52:e143-263.
3. Murphy JG, Gersh BJ, Mair DD, Fuster V, McGoon MD, Ilstrup DM, et al. Long-term outcome after surgical repair of isolated atrial septal defect. N Engl J Med 1990;323:1645-50.
4. Alkashkari W, Hijazi ZM. ASDs: clinical perspectives. In: Hijazi ZM, Feldman T, Abdullah Al-Qbandi MH, Sievert H, editors. Transcatheter Closure of ASDs and PFOs: A Comprehensive Assessment. Minneapolis, MN: Cardiotext Publishing, 2010:27-36.
5. Bogousslavsky J, Garazi S, Jeanrenaud X, Aebischer N, Van Melle G. Lausanne Stroke with Paradoxical Embolism Study Group. Stroke recurrence in patients with patent foramen ovale: the Lausanne study. Neurology 1996;46:1301-5.
6. Mas JL, Zuber M. Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack. French Study Group on Patent Foramen Ovale and Atrial Septal Aneurysm. Am Heart J 1995;130:1083-8.
7. Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001;345:1740-6.
8. Akhondi A, Gevorgyan R, Tseng CH, Slavin L, Dao C, Liebeskind DS, et al. The association of patent foramen ovale morphology and stroke size in patients with paradoxical embolism. Circ Cardiovasc Interv 2010;3:506-10.
9. Anzola GP, Magoni M, Guindani M, Rozzini L, Dalla Volta G. Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology 1999;52:1622-5.
10. Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K; Amplatzer Investigators. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 2002;39:1836-44.
11. Jones TK, Latson LA, Zahn E, Fleishman CE, Jacobson J, Vincent R, et al; Multicenter Pivotal Study of the HELEX Septal Occluder Investigators. Results of the US multicenter pivotal study of the HELEX septal occluder for percutaneous closure of secundum atrial septal defects. J Am Coll Cardiol 2007;49:2215-21.
12. Fiarresga A, De Sousa L, Martins JD, Ramos R, Paramés F, Freitas I, et al. Percutaneous closure of atrial septal defects: a decade of experience at a reference center. Rev Port Cardiol 2010;29:767-80.
13. Spies C, Timmermanns I, Schräder R. Transcatheter closure of secundum atrial septal defects in adults with the Amplatzer septal occluder: intermediate and long-term results. Clin Res Cardiol 2007;96:340-6.
14. Butera G, Romagnoli E, Carminati M, Chessa M, Piazza L, Negura D, et al. Treatment of isolated secundum atrial septal defects: impact of age and defect morphology in 1,013 consecutive patients. Am Heart J 2008;156:706-12.
15. Kutty S, Brown K, Asnes JD, Rhodes JF, Latson LA. Causes of recurrent focal neurologic events after transcatheter closure of patent foramen ovale with the CardioSEAL septal occluder. Am J Cardiol 2008;101:1487-92.
16. Spies C, Reissmann U, Timmermanns I, Schräder R. Comparison of contemporary devices used for transcatheter patent foramen ovale closure. J Invasive Cardiol 2008;20:442-7.
17. Everett AD, Jennings J, Sibinga E, Owada C, Lim DS, Cheatham J, et al. Community use of the Amplatzer atrial septal defect occluder: results of the multicenter MAGIC atrial septal defect study. Pediatr Cardiol 2009;30:240-7.
18. Forbes T. Interim results of the Amplatzer septal occluder post approval study. Paper presented at: PICS-AICS; July 23, 2011; Boston, MA.
19. W. L. Gore. Gore Helex Septal Occluder Clinical Report. Available at: http:// www.goremedical.com/resources/dam/assets/AR1456-EN3.pdf. Accessed December 4, 2012.
20. Latson LA, Jones TK, Jacobson J, Zahn E, Rhodes JF. Analysis of factors related to successful transcatheter closure of secundum atrial septal defects using the Helex septal occluder. Am Heart J 2006;151:1129.e7-11.
21. Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, et al; CLOSURE I Investigators. Study design of the CLOSURE I Trial: a prospective, multicenter, randomized, controlled trial to evaluate the safety and efficacy of the STARFlex septal closure system versus best medical therapy in patients with stroke or transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale. Stroke 2010;41:2872-83.
22. Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, et al; PC Trial Investigators. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 2013;368:1083-91.
23. Carroll JD, Saver JL, Thaler DE, Smalling RW, Berry S, MacDonald LA, et al; RESPECT Investigators. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med 2013;368:1092-100.
24. U.S. FDA. FDA Executive Summary Memorandum-May 24, 2012: Circulatory System Advisory Panel Meeting-Transcatheter ASD Occluders: Clinical Update and Review of Events (pdf). May 24, 2012. Available at: http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/ MedicalDevices/MedicalDevicesAdvisoryCommittee/CirculatorySystem. DevicesPanel/ucm300073.htm. Accessed December 4, 2012.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi