Ahmet Vedat KAVURT, Emine Gulsah TORUN, Ayben KİLİC, Denizhan BAĞRUL, Alper GÜRSU, İbrahim ECE, İbrahim İlker ÇETİN

Çocuklarda, Ergenlerde ve Genç Yetişkinlerde Transtorasik Ekokardiyografi ve Floroskopi Kılavuzluğunda Cihazla Transkateter Atriyal Septal Defekt Kapatılması

Amaç: Bu çalışmanın amacı, floroskopi ve transtorasik ekokardiyografi (TTE) eşliğinde transkateter atriyal septal defekt (ASD) kapatılmasının güvenlik ve etkinliğini değerlendirmek ve deneyimlerimizi sunmaktır. Gereç ve Yöntemler: Bu çalışmada transkateter ASD kapatılması için kateter laboratuvarına alınan 108 hastanın dosyası geriye dönük olarak incelendi. On hastada septum/cihaz orantısızlığı (6) ve başta vena cava inferior rimi olmak üzere eksik rimler (4) nedeniyle işlemden vazgeçildi. Bulgular: Toplam 98 hastaya (59 kadın) TTE rehberliğinde transkateter ASD kapatma uygulandı. Hastaların ortalama yaşı 9.5 ± 6 yıl (2.6-46) ve ortalama ağırlığı 30.3 ± 15.3 kg (12-80)’di. TTE kılavuzluğunda ASD kapatma 98 hastanın 92’sinde (%94) başarıyla uygulandı. TTE ile ölçülen en büyük ASD çapı ortanca değeri 10.75 mm (çeyrekler arası aralık (ÇAA) 9.12-14)’dü. Floroskopi ile ölçülen gerilmiş balon çapı ortanca değeri 14 mm (ÇAA 12.4-18)’di. Ortanca cihaz bel çapı 14 mm (ÇAA 13-18), ortanca cihaz sol atriyal (SlA) disk çapı 28 mm (ÇAA 26-31) ve SlA disk çapının toplam septal çapa oranı ortanca değeri %75 (ÇAA 68-81)’di. Ortanca floroskopi ve işlem süreleri sırasıyla 8 dakika (ÇAA 5.6-13.75) ve 36.5 dakika (ÇAA 30-49)’du. Sonuç: TTE ve floroskopi kılavuzluğunda transkateter ASD kapatılması çocuklarda, ergenlerde ve genç erişkinlerde güvenli ve etkilidir.

Anahtar Kelimeler:

Atriyal septal defekt, transtorasik ekokardiyografi, transkateter ASD kapatma.

Transthoracic Echocardiography and Fluoroscopy Guided Transcatheter Atrial Septal Defect Closure with Device in Children, Adolescents, and Young Adults

Objective: The aim of this study was to evaluate the safety and efficacy of transcatheter atrial septal defect (ASD) closure guided by fluoroscopy and transthoracic echocardiography (TTE) and to present our experiences. Material and Methods: In this study, we evaluated 108 patients’ files taken to the catheter laboratory for transcatheter ASD closure retrospectively. The procedure was abandoned in ten patients because of septum device disproportion (6) and deficient rims (4), mainly inferior vena cava rim. Results: Transcatheter ASD closure guided by TTE was performed in 98 patients (59 female). The mean age of patients was 9.5±6 years (2.6-46), and the mean weight was 30.3±15.3kg (12-80). TTE-guided ASD closure was successfully performed in 92 of 98 (94%) patients. The median largest ASD diameter measured by TTE was 10.75 mm (interquartile range (IQR) 9.12-14. The median stretched balloon diameter measured by fluoroscopy was 14 mm (IQR 12.4-18). The median device waist diameter was 14 mm (IQR 13-18), the median device left atrial (LA) disk diameter was 28 mm (IQR 26-31), and the median ratio of LA disc diameter to total septal diameter was 75% (IQR 68-81). The median fluoroscopy and procedural times were 8 minutes (IQR 5.6-13.75) and 36.5 minutes (IQR 30-49) respectively. Conclusion: Transcatheter ASD closure guided by TTE and fluoroscopy is safe and effective in children, adolescents, and young adults.

Keywords:

Atrial septal defect, transthoracic echocardiography, transcatheter ASD closure,

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