الفهرس 
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Abstract
This retrospective descriptive study aimed to evaluate 2.5 years experience in transcatheter device closure of secundum ASD at the Pediatric Cardiology Unit, Assiut University Children Hospital from March 2014 till September 2016.
Patients included were those suitable for transcatheter ASD device closure (significant ASD (QP/QS ≥ 1.5/1), right ventricular volume overload and were suitable for device closure (septal rims were 4 mm for children and 5 mm for adults) and they underwent closure of the defects.
We excluded those with unsuitable ASDs for device closure (large ASD size for weight, deficient rims, types other than secundum ASD, abnormal venous drainage, complex cardiac anomaly, severe pulmonary hypertension, newborns, children < 1 year or <10 Kg with asymptomatic small ASD.
The study was carried out by collecting the following data:
1. Patient‘s demography, vital signs, general and cardiac examinationsfindings.
2. CXR, ECG, CBC, renal function tests, serum electrolytes, prothrombin time and concentration and viral hepatitis B and C serologyresults.
3. TTE and TEE measurements and data about the device type and size, the delivery sheath diameter, procedure and fluoroscopy time and complications were collected. The procedure was performed under general anesthesia. All patients received IV antibiotics 1 day before and IV heparin (100 mg/kg) during theprocedure.
The patients were 56 (90.4%) children and 6 (9.6%) adults, 30 males and 32 females. The children age was 1-18 years (6.1±3.8 years) and grouped into three groups, 1-6 years(59.7%),7-12years(17.7%)and13-18years(12.9%)andoneadultsgroup
(19-50, 26±12.7 years). The children and adult weight was 10-33, 19.8±7.8 Kg and 41-86,63.5±20.8Kgrespectively.ThesizeoftheASDbyTTEandTEEwas
{15.7±5.6, 4.5-32 mm} and {18.3±6.9, 6-38 mm} respectively. There were 2 patients with small ASDs (< 5 mm), 15 patients with moderate (6-12 mm) and 45 with large ASDs (>12 mm). The ASD device size was {24.1±6.6, 9-40 mm} and device/defect ratio was {1.53±0.11,1.2-1.6}.
General and cardiac examinations were normal, apart from three cases with Down syndrome, cerebral palsy and renal failure on hemodialysis. Abnormal ECG findings were in 32.3%; right ventricular hypertrophy (12.9%), right atrial dilatation (4.9%), rsR’ pattern in V1-V3 (8%) and combination of right ventricular hypertrophy and right axis deviation (6.5%). Cardiomegaly by CXR was in 40.3%. Most ofpatients
(61.3%) were from rural areas. The ASD size was measured by TTE before and by TEE within the procedure under general anaesthesia. The ASD size was 15.7±5.6 mm (by TTE) and 18.3±6.9 mm (by TEE). The ASD size was significantly higher by TEE in children aged (1-6) and (13-18) years (13.9±4.8 and 14.8±3.8 mm) than by TTE (16.8±6.3 and 23.3±6.5 mm) p=0.029 and p=0.007 respectively. There was a significant positive correlation between the ASD size by TTE and TEE (r=0.854, P=0.000). There were significant positive correlations between the ASD size by TTE and TEE and the ASD device size (r=0.764, p=0.000 and r=0.650, p=0.000 respectively). The length of SVC, superior, aortic, AV valve and IVC rims was 10±4.3, 10.9±2.7, 3.8±1.9, 8±2 and 10.4±2.8 mm respectively and devices size was 24.1±6.6 mm. Three types of ASD closure devices were used: Amplatzer septal occlude (ASO) (92%), Occlutech septal occluder (Figulla–Occlutech Device) (FOD) (5%) and Amplatzer multifenestrated septal oocluder (cribriform occluder) (3%). The mean device/defect ratio was {1.53±0.11,(1.2-1.6)}.
Successful closure of secundum ASD was achieved in 98.3% of patients regarding the efficacy (successful closure of the defect without residual shunt) and safety (no deaths or major complications). In one case the device was removed because of complete heart block. Immediate and follow-up results of ASO implantations appear encouraging, with immediate complete closure. Some procedure difficulties occurred in 12.9% and minor complications occurred in 4.8% of patients during and after the ASD closure procedure. Device prolapse occurred in 2 cases, one because of prolapse of left disc into the right atrium and the other one because of flimsy IVC rim (pulmonary vein mid cavity release technique was done). Cobra head changes in the device shape were detected in 9.6% especially with (24-26 mm) device size. Three cases (4.8%) developed complications during the procedure as supraventricular tachycardia in one patient, complete heart block (so the device was removed) in another patient and cold extremities and shock in the third one. The patients were discharged 24 hours after the procedure on Aspirin 5mg/Kg/day once daily for sixmonths.
On follow up after 1, 3 and 6 months, the patients were going well with prompt ASD closure, no residual shunt across the device and no further complications except for three cases (4.8%), developed migraine, abdominal pain, vomiting, dizziness and cold extremities for three months afterclosure.