The efficacy of transcatheter device closure of atrial septal defect in elderly patients

doi:10.3877/cma.j.issn.2095-6568.2022.02.004

Abstract

Abstract:

Objective

To investigate the safety and efficacy of transcatheter device closure of atrial septal defect (ASD) in elderly patients.

Methods

Between March 2018 and February 2022, patients with secundum ASD who underwent transcatheter device closure in Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University were included. Echocardiographic data and 6 minutes' walk distance (6MWD) before and after the procedure were retrospectively collected.

Results

A total of 51 patients were enrolled. The age was (65.75±4.04) years old. And 19 of them were male. There were no major complications occurred during perioperative period. Right atrial diameter (RAD) [(41.24±4.56) mm vs. (39.25±4.83) mm,P＜0.001; (41.46±3.95) mm vs. (38.14±5.59) mm, P=0.001], right ventricular diameter (RVD) [(40.92±3.97) mm vs. (38.55±4.23) mm,P＜0.001; (41.39±3.53) mm vs.(36.71±4.38) mm, P<0.001)] and estimated pulmonary artery systolic pressure (PASP) [(39.82±8.31) mmHg vs. (32.76±6.34) mmHg,P＜0.001; (40.21±7.99) mmHg vs. (33.79±7.04) mmHg,P＜0.001] were significantly decreased at the second day and 1 month after procedure. The ratio of early diastolic transmitral flow velocity(E)to mitral annular motion velocity(e', E/e' ratio) (8.65±1.51 vs. 11.74±3.90,P=0.003)and left ventricular end-systolic and diastolic diameter[(29.29±3.43)mm vs.(30.89±3.94) mm,P=0.007;（44.43±4.09）mm vs.（46.57±4.06）mm，P=0.008] increased significantly at 1 month after procedure. Left ventricular ejection fraction (LVEF) did not differ significantly between baseline and after procedure. The result of 6MWD was significantly improved at 1 month after procedure (the proportion of moderate to severe abnormal was 64.3% vs. 28.6%, P=0.007).

Conclusion

Transcatheter device closure in the elderly patients were of good safety and improved exercise capacity and right ventricular function.

Key words: Atrial septal defect, Transcatheter device closure, Exercise capacity, Cardiac reverse remodeling

Hui Shen, Jingyu Sun, Minshan Zhong, Jing Shi, Wei Sun. The efficacy of transcatheter device closure of atrial septal defect in elderly patients[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(02): 88-92.

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URL: https://zhxzyxldzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-6568.2022.02.004

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Figures/Tables 4

项目	数值
年龄（岁， $x ¯ ± s$ ）	65.75±4.04
男性［例（%）］	19（37.3）
体重指数（kg/m²， $x ¯ ± s$ ）	23.50±2.62
合并症［例（%）］
心房颤动或心房扑动	15（29.4）
冠心病	10（19.6）
高血压	25（49.0）
糖尿病	8（15.7）
脑卒中	8（15.7）
心导管检查
肺动脉压（mmHg， $x ¯ ± s$ ）	23.51±5.40
Qp/Qs（ $x ¯ ± s$ ）	2.39±1.07
肺小动脉阻力（Wood， $x ¯ ± s$ ）	2.61±0.95
肺动脉高压［例（%）］	18（35.3）
房间隔缺损大小（mm， $x ¯ ± s$ ）	18.25±5.97
实验室检查
NT-proBNP［pg/ml，M（IQR）］	315.3（84.0，892.0）
血红蛋白（g/L， $x ¯ ± s$ ）	136.80±13.96
血清肌酐（μmol/L， $x ¯ ± s$ ）	66.47±13.69

项目	数值
年龄（岁， $x ¯ ± s$ ）	65.75±4.04
男性［例（%）］	19（37.3）
体重指数（kg/m²， $x ¯ ± s$ ）	23.50±2.62
合并症［例（%）］
心房颤动或心房扑动	15（29.4）
冠心病	10（19.6）
高血压	25（49.0）
糖尿病	8（15.7）
脑卒中	8（15.7）
心导管检查
肺动脉压（mmHg， $x ¯ ± s$ ）	23.51±5.40
Qp/Qs（ $x ¯ ± s$ ）	2.39±1.07
肺小动脉阻力（Wood， $x ¯ ± s$ ）	2.61±0.95
肺动脉高压［例（%）］	18（35.3）
房间隔缺损大小（mm， $x ¯ ± s$ ）	18.25±5.97
实验室检查
NT-proBNP［pg/ml，M（IQR）］	315.3（84.0，892.0）
血红蛋白（g/L， $x ¯ ± s$ ）	136.80±13.96
血清肌酐（μmol/L， $x ¯ ± s$ ）	66.47±13.69

时间

轻度异常或正常

［例（%）］

中重度异常

［例（%）］

项目	术前	术后	差值（95%CI）	P值
右心房内径（mm）	41.24±4.56	39.25±4.83	1.98（0.98，2.98）	＜0.001
右心室内径（mm）	40.92±3.97	38.55±4.23	2.37（1.40，3.35）	＜0.001
左心房内径（mm）	38.47±5.39	37.00±4.02	1.47（0.42，2.53）	0.007
左心室收缩末期内径（mm）	29.29±3.04	30.08±3.94	-0.78（-1.77，0.21）	0.118
左心室舒张末期内径（mm）	44.49±3.82	45.53±4.18	-1.04（-2.12，0.04）	0.058
估测PASP（mmHg）	39.82±8.31	32.76±6.34	7.06（4.68，9.44）	＜0.001
左心室射血分数（%）	63.23±3.46	63.71±3.38	-0.48（-1.30，0.34）	0.249
E/e’	8.48±1.59	9.68±3.02	-1.21（-2.21，-0.20）	0.020
E/A	0.78±0.25	0.85±0.24	-0.06（-0.15，0.02）	0.140

项目	术前	术后1个月	差值（95%CI）	P值
右心房内径（mm）	41.46±3.95	38.14±5.59	3.32（1.49，5.15）	0.001
右心室内径（mm）	41.39±3.53	36.71±4.38	4.68（3.00，6.35）	＜0.001
左心房内径（mm）	38.04±5.27	39.25±5.50	-1.21（-2.52，0.09）	0.066
左心室收缩末期内径（mm）	29.29±3.43	30.89±3.94	-1.60（-2.75，-0.47）	0.007
左心室舒张末期内径（mm）	44.43±4.09	46.57±4.06	-2.14（-3.69，-0.60）	0.008
估计PASP（mmHg）	40.21±7.99	33.79±7.04	6.43（3.53，9.33）	＜0.001
左心室射血分数（%）	63.25±4.13	62.71±4.80	0.54（-0.94，2.02）	0.462
E/e’	8.65±1.51	11.74±3.90	-3.09（-4.97，-1.20）	0.003
E/A	0.83±0.23	1.06±0.42	-0.23（-0.42，-0.03）	0.027

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