ABSTRACT
Objective To evaluate the clinical safety, efficacy and long-term outcome of transcatheter occlusion for ruptured aortic sinus of valsalva aneurysm (RASA) into the right atrium.Methods Between January 2006 and April 2013, fifteen patients [11 males and 4 females,aged from 21 to 48 years with an mean age of (35.50±8.79) years] with RASA ruptured into the right atrium were enrolled in this study.Domestic made patent ductus arteriosus (applied in six patients) or small waist double-disk ventricular septal defect (applied in nine patients) occluders were used for transcatheter closure.All the patients were followed up for any change in cardiac rhythm,and residual shunt,occluders morphology and possible valve regurgitation by echocardiography.Results All RASA were confirmed by aortography,including eleven cases with rupture of right coronary sinus of valsalva and four cases with rupture of the noncoronary sinus of valsalva shunting into the right atrium.NYHA function class was(2.56±0.63)before the occlusion.Cardiac catheterization showed mean pulmonary arterial pressure and Qp/Qs ratio were (25.38±8.21)mmHg (1 mmHg=0.133 kPa) and 1.34-2.81(1.93±0.39), respectively.Aortic angiography showed that the RSA was 4-10(6.42±1.92)mm at its narrowest end.There was no serious complication during the operation and all the patients had successful transcatheter closure without residual shunt.After transcatheter RASA occlusion, mean pulmonary artery pressure decreased to (16.1±5.3) mmHg (P<0.05).The diameter of right atrium,right ventricle, left atrium and pulmonary artery diameter and left ventricular end-diastolic dimension all showed significant decrease (P<0.01).All patients were followed up for 35-132(78.6±28.57)months.All patients presented with a NYHA function class Ⅰ to Ⅱ cardiac function in their last follow up which was significantly improved compare to pre-occlusion level (P<0.01).There were no infective endocarditis,device displacement and embolism,serious aortic regurgitation,myocardial ischemia,serious arrhythmia or death in any of the patients during follow up.Conclusions Transcatheter closure of Valsalva aneurysm ruptured into right atrium with the domestic made patient ductus arteriosus and small-waist ventricular septal defect occluder is safe and effective with a good long term prognosis.
ABSTRACT
Objective To evaluate clinical effectiveness of transcatheter closure of atrial septal defects ( ASD) with severe pulmonary arterial hyperyension ( sPAH) by fenestrated Amplatzer septal occluders ( ASO) . Methods From September 2002 to April 2013, 17 patients of ASD with sPAH received transcatheter ASD closure using fenestrated occluders. Aged from 18 - 72 years, the diameters of ASDs were 18 - 33 mm. The systolic pulmonary arterial hypertension measured by transthoracic echocardiogram were 80 - 112 (96. 9 ± 8. 9) mmHg. The follow-up study included electrocardiography, chest radiography and echocardiography. All the patients were followed up for 1. 5 - 12 ( mean 6. 4 ± 0. 7) years. Results Systolic pulmonary arterial pressure (sPAP) of 60 - 108 (88. 7 ± 11. 7) mmHg and mean pulmonary artery pressure ( mPAP) of 29. 3 - 60 (51. 0 ± 8. 1) mmHg were measured by cardiac catheterization before ASD closure. Qp/ Qs was 1. 50 - 2. 44 (1. 8 ± 0. 31) and the pulmonary vascular resistance was 3. 1 - 9. 7 (5. 6 ± 1. 5) wood units (wu) . Immediately after the implantation of fenestrated occluders, sPAP decreased to 56 - 99 (70 ± 11. 5) mmHg and mPAP to 27 - 51. 7 (41. 1 ± 7. 1) mmHg. On the 3 d, 3 m and 6 m follow-up exam, RVEDd decreased ( P ﹤ 0. 05), while LVEDd, LVEDV and LVEF increased significantly (P ﹤ 0. 05) . sPAP decreased significantly after transcatheter closure at 3 m and 6 m as compared to pre-closure levels (both P ﹤ 0. 05) . The mean sPAP in long term follow up was (60. 2 ± 13. 3) mmHg which had significant decrease compared to pre-closure level ( P ﹤ 0. 01), but no significant difference found when compared to 6 m follow up (P ﹥ 0. 05). Conclusions ASD closure with fenestrated ASO is a satisfactory approach for ASD with severe PAH.