Successful totally transthoracic echocardiography guided transcatheter device closure of atrial septal defect in pregnant women
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摘要
BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography(TTE),even in pregnant women with ASD.AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.METHODS Six pregnant women(gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.RESULTS All patients had successful closure with good clinical results,and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm(26.7 ± 4.3 mm),the procedure time ranged from 30 to50 min(41.7 ± 7.5 min),and the length of hospital stay was 2-3 d(mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications,and transient arrhythmias occurred in one patient during the procedure. During the follow-up period(3 mo to 2 years),no occluder dislodgement,residual fistulas,or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.
BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography(TTE),even in pregnant women with ASD.AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.METHODS Six pregnant women(gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.RESULTS All patients had successful closure with good clinical results,and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm(26.7 ± 4.3 mm),the procedure time ranged from 30 to50 min(41.7 ± 7.5 min),and the length of hospital stay was 2-3 d(mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications,and transient arrhythmias occurred in one patient during the procedure. During the follow-up period(3 mo to 2 years),no occluder dislodgement,residual fistulas,or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.
BACKGROUND Transcatheter device closure of atrial septal defect(ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography(TTE),even in pregnant women with ASD.AIM To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.METHODS Six pregnant women(gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.RESULTS All patients had successful closure with good clinical results,and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm(26.7 ± 4.3 mm),the procedure time ranged from 30 to50 min(41.7 ± 7.5 min),and the length of hospital stay was 2-3 d(mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications,and transient arrhythmias occurred in one patient during the procedure. During the follow-up period(3 mo to 2 years),no occluder dislodgement,residual fistulas,or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.CONCLUSION Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.
引文
1 Geva T,Martins JD,Wald RM.Atrial septal defects.Lancet 2014;383:1921-1932[PMID:24725467DOI:10.1016/S0140-6736(13)62145-5]
2 Actis Dato GM,Rinaudo P,Revelli A,Actis Dato A,Punta G,Centofanti P,CavagliàM,Barbato L,Massobrio M.Atrial septal defect and pregnancy:a retrospective analysis of obstetrical outcome before and after surgical correction.Minerva Cardioangiol 1998;46:63-68[PMID:9677799]
3 Luo H,Wang J,Qiao C,Zhang X,Zhang W,Song L.Evaluation of different minimally invasive techniques in the surgical treatment of atrial septal defect.J Thorac Cardiovasc Surg 2014;148:188-193[PMID:24100102 DOI:10.1016/j.jtcvs.2013.08.017]
4 Aytemir K,Oto A,?zkutlu S,Canpolat U,Kaya EB,Yorgun H,?ahiner L,Sunman H,Ate?AH,Kabak??G.Transcatheter interatrial septal defect closure in a large cohort:midterm follow-up results.Congenit Heart Dis 2013;8:418-427[PMID:23601507 DOI:10.1111/chd.12057]
5 Hoashi T,Yazaki S,Kagisaki K,Kitano M,Kubota SM,Shiraishi I,Ichikawa H.Management of ostium secundum atrial septal defect in the era of percutaneous trans-catheter device closure:7-Year experience at a single institution.J Cardiol 2015;65:418-422[PMID:25113951 DOI:10.1016/j.jjcc.2014.07.009]
6 Houser L,Zaragoza-Macias E,Jones TK,Aboulhosn J.Transcatheter closure of atrial septal communication during pregnancy in women with Ebstein's anomaly of the tricuspid valve and cyanosis.Catheter Cardiovasc Interv 2015;85:842-846[PMID:25511470 DOI:10.1002/ccd.25787]
7 Orchard EA,Wilson N,Ormerod OJ.Device closure of atrial septal defect during pregnancy for recurrent cerebrovascular accidents.Int J Cardiol 2011;148:240-241[PMID:19942309 DOI:10.1016/j.ijcard.2009.10.049]
8 Soydemir DF,Johnston T,Clarke B.Percutaneous closure of an atrial septal defect during pregnancy using an Amplatzer occlusion device.J Obstet Gynaecol 2005;25:715-716[PMID:16263552 DOI:10.1080/01443610500304307]
9 Cao H,Chen Q,Zhang GC,Chen LW,Qiu ZH,Lu H.Percutaneous device closure of atrial septal defect with totally transthoracic echocardiography guide,without x-ray machine.Medicine(Baltimore)2016;95:e5256[PMID:27858888 DOI:10.1097/MD.0000000000005256]
10 Liu H,Huang T,Zhao W,Shen Y,Lin J.Pregnancy outcomes and relative risk factors among Chinese women with congenital heart disease.Int J Gynaecol Obstet 2013;120:245-248[PMID:23245675 DOI:10.1016/j.ijgo.2012.09.025]
11 Piesiewicz W,Goch A,Binikowski Z,Faflik U,Krasomski G,Goch JH.Changes in the cardiovascular system during pregnancy in women with secondary atrial septal defect.Kardiol Pol 2004;60:218-228[PMID:15156217]
12 Niwa K.Adult Congenital Heart Disease with Pregnancy.Korean Circ J 2018;48:251-276[PMID:29625509 DOI:10.4070/kcj.2018.0070]
13 Yap SC,Drenthen W,Meijboom FJ,Moons P,Mulder BJ,Vliegen HW,van Dijk AP,Jaddoe VW,Steegers EA,Roos-Hesselink JW,Pieper PG;ZAHARA investigators.Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect.BJOG 2009;116:1593-1601[PMID:19681849 DOI:10.1111/j.1471-0528.2009.02301.x]
14 Warnes CA.Pregnancy and Delivery in Women With Congenital Heart Disease.Circ J 2015;79:1416-1421[PMID:26040336 DOI:10.1253/circj.CJ-15-0572]
15 Davidson WR.Pregnancy in Adult Congenital Heart Disease:Special Delivery.JAMA Cardiol 2017;2:671-672[PMID:28403448 DOI:10.1001/jamacardio.2017.0365]
16 Ladouceur M,Benoit L,Basquin A,Radojevic J,Hauet Q,Hascoet S,Moceri P,Le Gloan L,Amedro P,Lucron H,Richard A,Gouton M,Nizard J.How Pregnancy Impacts Adult Cyanotic Congenital Heart Disease:A Multicenter Observational Study.Circulation 2017;135:2444-2447[PMID:28606952 DOI:10.1161/CIRCULATIONAHA.116.027152]
17 Salazar E,Espinola N,Molina FJ,Reyes A,Barragán R.Heart surgery with cardiopulmonary bypass in pregnant women.Arch Cardiol Mex 2001;71:20-27[PMID:11565358]
18 Manivannan S,Dadlani G,Parsons M,Crisan L,Belogolovkin V,Sastry N,Guglin M.Surgical repair of atrial septal defect with severe pulmonary hypertension during pregnancy:a case report with literature review.Cardiol Young 2012;22:493-498[PMID:22717278 DOI:10.1017/S1047951112000492]
19 Brent RL.Saving lives and changing family histories:appropriate counseling of pregnant women and men and women of reproductive age,concerning the risk of diagnostic radiation exposures during and before pregnancy.Am J Obstet Gynecol 2009;200:4-24[PMID:19121655 DOI:10.1016/j.ajog.2008.06.032]
20 Miglioretti DL,Johnson E,Williams A,Greenlee RT,Weinmann S,Solberg LI,Feigelson HS,Roblin D,Flynn MJ,Vanneman N,Smith-Bindman R.The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk.JAMA Pediatr 2013;167:700-707[PMID:23754213 DOI:10.1001/jamapediatrics.2013.311]
21 Pearce MS,Salotti JA,Little MP,McHugh K,Lee C,Kim KP,Howe NL,Ronckers CM,Rajaraman P,Sir Craft AW,Parker L,Berrington de González A.Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours:a retrospective cohort study.Lancet 2012;380:499-505[PMID:22681860 DOI:10.1016/S0140-6736(12)60815-0]
22 Orchard E,Dix S,Wilson N,Mackillop L,Ormerod O.Reducing ionizing radiation doses during cardiac interventions in pregnant women.Obstet Med 2012;5:108-111[PMID:27582866 DOI:10.1258/om.2012.120006]
23 Pierce T,Hovnanian M,Hedgire S,Ghoshhajra B.Imaging of Cardiovascular Disease in Pregnancy and the Peripartum Period.Curr Treat Options Cardiovasc Med 2017;19:94[PMID:29134367 DOI:10.1007/s11936-017-0593-8]
24 Vidaillet HJ,Skelton TN,Kisslo KB,Kisslo J,Bashore TM.Echocardiographic guidance of cardiac catheterization for atrial septal defect in pregnancy.Am J Cardiol 1986;58:1133-1134[PMID:3776875]
25 Azhar AS.Safety and efficacy of transthoracic versus transesophageal echocardiography in transcatheter closure of atrial septal defects.Reporting a single center experience from Saudi Arabia.Saudi Med J 2016;37:1196-1205[PMID:27761557 DOI:10.15537/smj.2016.11.15617]
26 Pan XB,Ou-Yang WB,Pang KJ,Zhang FW,Wang SZ,Liu Y,Zhang DW,Guo GL,Tian PS,Hu SS.Percutaneous Closure of Atrial Septal Defects Under Transthoracic Echocardiography Guidance Without Fluoroscopy or Intubation in Children.J Interv Cardiol 2015;28:390-395[PMID:26077469 DOI:10.1111/joic.12214]
2 Actis Dato GM,Rinaudo P,Revelli A,Actis Dato A,Punta G,Centofanti P,CavagliàM,Barbato L,Massobrio M.Atrial septal defect and pregnancy:a retrospective analysis of obstetrical outcome before and after surgical correction.Minerva Cardioangiol 1998;46:63-68[PMID:9677799]
3 Luo H,Wang J,Qiao C,Zhang X,Zhang W,Song L.Evaluation of different minimally invasive techniques in the surgical treatment of atrial septal defect.J Thorac Cardiovasc Surg 2014;148:188-193[PMID:24100102 DOI:10.1016/j.jtcvs.2013.08.017]
4 Aytemir K,Oto A,?zkutlu S,Canpolat U,Kaya EB,Yorgun H,?ahiner L,Sunman H,Ate?AH,Kabak??G.Transcatheter interatrial septal defect closure in a large cohort:midterm follow-up results.Congenit Heart Dis 2013;8:418-427[PMID:23601507 DOI:10.1111/chd.12057]
5 Hoashi T,Yazaki S,Kagisaki K,Kitano M,Kubota SM,Shiraishi I,Ichikawa H.Management of ostium secundum atrial septal defect in the era of percutaneous trans-catheter device closure:7-Year experience at a single institution.J Cardiol 2015;65:418-422[PMID:25113951 DOI:10.1016/j.jjcc.2014.07.009]
6 Houser L,Zaragoza-Macias E,Jones TK,Aboulhosn J.Transcatheter closure of atrial septal communication during pregnancy in women with Ebstein's anomaly of the tricuspid valve and cyanosis.Catheter Cardiovasc Interv 2015;85:842-846[PMID:25511470 DOI:10.1002/ccd.25787]
7 Orchard EA,Wilson N,Ormerod OJ.Device closure of atrial septal defect during pregnancy for recurrent cerebrovascular accidents.Int J Cardiol 2011;148:240-241[PMID:19942309 DOI:10.1016/j.ijcard.2009.10.049]
8 Soydemir DF,Johnston T,Clarke B.Percutaneous closure of an atrial septal defect during pregnancy using an Amplatzer occlusion device.J Obstet Gynaecol 2005;25:715-716[PMID:16263552 DOI:10.1080/01443610500304307]
9 Cao H,Chen Q,Zhang GC,Chen LW,Qiu ZH,Lu H.Percutaneous device closure of atrial septal defect with totally transthoracic echocardiography guide,without x-ray machine.Medicine(Baltimore)2016;95:e5256[PMID:27858888 DOI:10.1097/MD.0000000000005256]
10 Liu H,Huang T,Zhao W,Shen Y,Lin J.Pregnancy outcomes and relative risk factors among Chinese women with congenital heart disease.Int J Gynaecol Obstet 2013;120:245-248[PMID:23245675 DOI:10.1016/j.ijgo.2012.09.025]
11 Piesiewicz W,Goch A,Binikowski Z,Faflik U,Krasomski G,Goch JH.Changes in the cardiovascular system during pregnancy in women with secondary atrial septal defect.Kardiol Pol 2004;60:218-228[PMID:15156217]
12 Niwa K.Adult Congenital Heart Disease with Pregnancy.Korean Circ J 2018;48:251-276[PMID:29625509 DOI:10.4070/kcj.2018.0070]
13 Yap SC,Drenthen W,Meijboom FJ,Moons P,Mulder BJ,Vliegen HW,van Dijk AP,Jaddoe VW,Steegers EA,Roos-Hesselink JW,Pieper PG;ZAHARA investigators.Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect.BJOG 2009;116:1593-1601[PMID:19681849 DOI:10.1111/j.1471-0528.2009.02301.x]
14 Warnes CA.Pregnancy and Delivery in Women With Congenital Heart Disease.Circ J 2015;79:1416-1421[PMID:26040336 DOI:10.1253/circj.CJ-15-0572]
15 Davidson WR.Pregnancy in Adult Congenital Heart Disease:Special Delivery.JAMA Cardiol 2017;2:671-672[PMID:28403448 DOI:10.1001/jamacardio.2017.0365]
16 Ladouceur M,Benoit L,Basquin A,Radojevic J,Hauet Q,Hascoet S,Moceri P,Le Gloan L,Amedro P,Lucron H,Richard A,Gouton M,Nizard J.How Pregnancy Impacts Adult Cyanotic Congenital Heart Disease:A Multicenter Observational Study.Circulation 2017;135:2444-2447[PMID:28606952 DOI:10.1161/CIRCULATIONAHA.116.027152]
17 Salazar E,Espinola N,Molina FJ,Reyes A,Barragán R.Heart surgery with cardiopulmonary bypass in pregnant women.Arch Cardiol Mex 2001;71:20-27[PMID:11565358]
18 Manivannan S,Dadlani G,Parsons M,Crisan L,Belogolovkin V,Sastry N,Guglin M.Surgical repair of atrial septal defect with severe pulmonary hypertension during pregnancy:a case report with literature review.Cardiol Young 2012;22:493-498[PMID:22717278 DOI:10.1017/S1047951112000492]
19 Brent RL.Saving lives and changing family histories:appropriate counseling of pregnant women and men and women of reproductive age,concerning the risk of diagnostic radiation exposures during and before pregnancy.Am J Obstet Gynecol 2009;200:4-24[PMID:19121655 DOI:10.1016/j.ajog.2008.06.032]
20 Miglioretti DL,Johnson E,Williams A,Greenlee RT,Weinmann S,Solberg LI,Feigelson HS,Roblin D,Flynn MJ,Vanneman N,Smith-Bindman R.The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk.JAMA Pediatr 2013;167:700-707[PMID:23754213 DOI:10.1001/jamapediatrics.2013.311]
21 Pearce MS,Salotti JA,Little MP,McHugh K,Lee C,Kim KP,Howe NL,Ronckers CM,Rajaraman P,Sir Craft AW,Parker L,Berrington de González A.Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours:a retrospective cohort study.Lancet 2012;380:499-505[PMID:22681860 DOI:10.1016/S0140-6736(12)60815-0]
22 Orchard E,Dix S,Wilson N,Mackillop L,Ormerod O.Reducing ionizing radiation doses during cardiac interventions in pregnant women.Obstet Med 2012;5:108-111[PMID:27582866 DOI:10.1258/om.2012.120006]
23 Pierce T,Hovnanian M,Hedgire S,Ghoshhajra B.Imaging of Cardiovascular Disease in Pregnancy and the Peripartum Period.Curr Treat Options Cardiovasc Med 2017;19:94[PMID:29134367 DOI:10.1007/s11936-017-0593-8]
24 Vidaillet HJ,Skelton TN,Kisslo KB,Kisslo J,Bashore TM.Echocardiographic guidance of cardiac catheterization for atrial septal defect in pregnancy.Am J Cardiol 1986;58:1133-1134[PMID:3776875]
25 Azhar AS.Safety and efficacy of transthoracic versus transesophageal echocardiography in transcatheter closure of atrial septal defects.Reporting a single center experience from Saudi Arabia.Saudi Med J 2016;37:1196-1205[PMID:27761557 DOI:10.15537/smj.2016.11.15617]
26 Pan XB,Ou-Yang WB,Pang KJ,Zhang FW,Wang SZ,Liu Y,Zhang DW,Guo GL,Tian PS,Hu SS.Percutaneous Closure of Atrial Septal Defects Under Transthoracic Echocardiography Guidance Without Fluoroscopy or Intubation in Children.J Interv Cardiol 2015;28:390-395[PMID:26077469 DOI:10.1111/joic.12214]
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