YF Cheung, AKT Chau, TC Yung, KS Lun

Abstract

Purpose: We reviewed our experience in the closure of right-to-left atrial shunts using Amplatzer septal occluders. Methods: This is a retrospective review of 13 patients who underwent transcatheter closure of right-to-left atrial shunts for systemic hypoxaemia, at a median age of 8.0 years (range, 2.1 to 17.5), between April 1998 and March 2005. Results: The right-to-left shunts were associated with Fontan fenestrations (n=8), pulmonary atresia post right ventricular outflow tract reconstruction (RVOTR) (n=3), and critical pulmonary stenosis post-balloon valvoplasty (n=1) and RVOTR (n=1). The median procedural and fluoroscopic times were 140 minutes (range, 75 to 250) and 23 minutes (range, 13 to 55), respectively. A single occluder, with size ranging from six to 24 mm, was placed in 12 patients, while two (17 mm and 20 mm) occluders were deployed in one. There were no procedural failures or immediate complications. Systemic arterial oxygen saturation increased from 81.0±9.0% to 94.9±2.4% (p=0.008), while the mean right atrial pressure increased slightly from 11.8±3.6 to 13.5±3.5 mmHg (p=0.013) after the procedure. The median follow-up duration was 63 months (range, 7 to 75). One patient developed transient ischaemic attacks within the first week of device implantation. Follow-up echocardiography revealed no leak through the implanted devices, although residual shunts through additional small atrial communications were noted in four patients. Conclusion: Amplatzer septal occluder effectively eliminates right-to-left atrial shunts with significant improvement in systemic arterial oxygenation. Serial monitoring for systemic venous congestion is, however, warranted.

目的：我們回顧我們應用 Amplatzer 間隔封堵器關閉右向左心房分流的經驗。方法：回顧 1988 年 4 月至 2005 年 3 月期間，因系統低氧血症而接受經導管關閉右向左心房分流的 13 個病人，平均年齡 8 歲（2.1 至 17.5 歲），而作出評價。結果：右向左分流是和 Fontan 開孔（n=8），肺動脈閉鎖右室流出道重建（RVOTR）（n=3 ），以及嚴重肺動脈瓣狹窄經球囊瓣膜成形術（n=1）。RVOTR （n=1）後有關。平均手術和 X 綫透視時間分別為 140 分鐘（75 至 250 分鐘）和 23 分鐘（13 至 55 分鐘）。12 個病人被放置尺寸大小為 6 至 24 mm 的單個封堵器。一個病人放置2個封堵器（17 mm 及 20 mm）。沒有手術失敗或即刻併發症的病例。封堵後，系統動脈氧飽和度從 81.0±9.0% 升至 94.9±2.4%（p=0.008），而平均右房壓從 11.8±3.6 到 13.5±3.5 mmHg（p=0.013），顯示輕微增加。平均隨訪期為 63 個月（7 至 75 月）。一個病人在裝置植入後第一週內有短暫的缺血現象。隨訪超聲心動圖顯示沒有滲漏通過植入的裝置。雖然在 4 個病人中，有殘餘分流通過另外的小心房交通。結論：Amplatzer 間隔封堵器有效地消除了右向左心房分流，顯著地改善了系統動脈氧飽和度。對系統靜脈充血的系列監測無論如何是有理由的。