Abstract
Background To evaluate the feasibility of using a single device to close multiple atrial septal defects (ASDs) under the guidance of transthoracic echocardiography (TTE) and with the aid of three-dimensional (3D) printing models. Methods Sixty-two patients with multiple ASDs were retrospectively analyzed. Thirty of these patients underwent TTE-guided closure (3D printing and TTE group) after a simulation of occlusion in 3D printing models. The remaining 32 patients underwent ASD closure under fluoroscopic guidance (conventional group). Closure status was assessed immediately and at 6 months after device closure. Results Successful transcatheter closure with a single device was achieved in 26 patients in the 3D printing and TTE group and 27 patients in the conventional group. Gender, age [18.8 ± 15.9 (3–51) years in the 3D printing and TTE group; 14.0 ± 11.6 (3–50) years in the conventional group], mean maximum distance between defects, prevalence of 3 atrial defects and large defect distance (defined as distance ≥7 mm), and occluder size used were similarly distributed between groups. However, the 3D printing and TTE group had lower frequency of occluder replacement (3.8% vs 59.3%, p < 0.0001), prevalence of mild residual shunts (defined as <5 mm) immediately (19.2% vs 44.4%, p < 0.05) and at 6 months (7.7% vs 29.6%, p < 0.05) after the procedure, and cost (32960.8 ± 2018.7 CNY vs 41019.9 ± 13758.2 CNY, p < 0.01). Conclusion The combination of the 3D printing technology and ultrasound-guided interventional procedure provides a reliable new therapeutic approach for multiple ASDs, especially for challenging cases with large defect distance.
Highlights
Percutaneous transcatheter closure of secundum atrial septal defect (ASD), an established alternative to surgical repair [1], remains challenging in the approximately 10% of cases with multiple atrial septal defects (ASDs) [2]
Use of single device closure for multiple ASDs after balloon atrial septostomy to tear the rim of tissue between the defects or using an oversized device to cover all defects [9, 10] is associated with risk of tearing the atrial septum. erefore, single device closure that preserves anatomical structure remains the optimal strategy for patients with multiple ASDs
In the 3D printing and transthoracic echocardiography (TTE) group, of 30 eligible patients, 4 patients (25.8 ± 17.5 years old; 1 female) were excluded because the residual shunt and/or the distance between the occluder and the mitral valve did not meet the criteria during pre-evaluation in the 3D printing heart model before intervention
Summary
Percutaneous transcatheter closure of secundum atrial septal defect (ASD), an established alternative to surgical repair [1], remains challenging in the approximately 10% of cases with multiple ASDs [2]. Erefore, single device closure that preserves anatomical structure remains the optimal strategy for patients with multiple ASDs. On the other hand, use of single device closure for multiple ASDs after balloon atrial septostomy to tear the rim of tissue between the defects or using an oversized device to cover all defects [9, 10] is associated with risk of tearing the atrial septum. Erefore, single device closure that preserves anatomical structure remains the optimal strategy for patients with multiple ASDs This strategy is technically challenging because of inability to determine the target defect for catheter passage and occluder selection, warranting careful interventional planning with comprehensive anatomical information for successful device closure. Efficiency of single device closure may be increased by use of 3D printed models to inform interventional management, including the selection of optimal target defect and device size, and by using echocardiography for procedure guidance. Conclusion. e combination of the 3D printing technology and ultrasound-guided interventional procedure provides a reliable new therapeutic approach for multiple ASDs, especially for challenging cases with large defect distance
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