Atriyal Septal Defekt ve Patent Foramen Ovale: Perkütan Kapatma Stratejileri
Özet
Atriyal septal defekt (ASD), yetişkinlerde en sık görülen konjenital kalp defektlerinden biridir ve komplikasyonları arasında atriyal aritmiler, pulmoner hipertansiyon ve Eisenmenger sendromu yer alır. ASD'nin perkütan yolla kapatılması, minimal invaziv bir teknik olup cerrahiye alternatif olarak sunulmaktadır. Patent foramen ovale(PFO) ise nüfusun %20-34'ünde görülür ve genellikle belirti vermez. PFO, kriptojenik inme, sistemik emboli, auralı migren ve dekompresyon hastalığı gibi klinik durumlarla ilişkili olabilir. Perkütan PFO kapatma, dikkatlice seçilmiş hastalarda etkili bir tedavi yöntemidir.PFO ve sekundum tip ASD transkateter kapatılması yaygın transkateter prosedürlerdir. Birçok teknik ayrıntıyı paylaşmalarına rağmen, bu prosedürler iki farklı klinik endikasyonu hedeflemektedir. PFO kapatılması genellikle tekrarlayan embolik inme/sistemik arteriyel embolizasyonu önlemek için düşünülürken, ASD kapatılması büyük soldan sağa şantı, sağ ventrikül hacim yüklenmesi ve normal pulmoner vasküler direnci olan hastalarda endikedir. Transözofageal ekokardiyografi/intrakardiyak ekokardiyografi artık bu tür prosedürleri güvenli ve etkili bir şekilde sunmak için giderek daha fazla kullanılmaktadır. Girişimsel kardiyolog, nöroradyolog ve kardiyak görüntülemeci arasındaki uzun süreli işbirliği esastır.
Atrial septal defect(ASD) is one of the most common congenital heart defects in adults and its complications include atrial arrhythmias, pulmonary hypertension and Eisenmenger syndrome. Percutaneous closure of ASD is a minimally invasive technique and is offered as an alternative to surgery. Patent foramen ovale (PFO) is seen in 20-34% of the population and is usually asymptomatic. PFO may be associated with clinical conditions such as cryptogenic stroke, systemic embolism, migraine with aura and decompression sickness. Percutaneous PFO closure is an effective treatment method in carefully selected patients. Transcatheter closure of PFO and secundum type ASD are common transcatheter procedures. Although they share many technical details, these procedures target two different clinical indications. While PFO closure is generally considered to prevent recurrent embolic stroke/systemic arterial embolization, ASD closure is indicated in patients with a large left-to-right shunt, right ventricular volume overload, and normal pulmonary vascular resistance. Transesophageal echocardiography/intracardiac echocardiography is now increasingly used to deliver such procedures safely and effectively. Long-term collaboration between the interventional cardiologist, neuroradiologist, and cardiac imaging specialist is essential.
Referanslar
Van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011;58:2241-7.
Helmut BA, Julie De BA, Sonya V. Et al. 2020 ESC Guidelines for the management of adult congenital heart disease. European Heart Journal 2021; 42; 563-645
Kotowycz MA, Therrien J, Ionescu-Ittu R, et al. Long-term outcomes after surgical versus transcatheter closure of atrial septal defects in adults. JACC Cardiovasc Interv 2013; 6:497.
Butera G, Biondi-Zoccai G, Sangiorgi G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: a systematic review and meta-analysis of currently available clinical evidence. EuroIntervention 2011; 7:377.
Baumgartner, H., & De Backer, J. (2020). The ESC Clinical Practice Guidelines for the Management of Adult Congenital Heart Disease 2020. European heart journal, 41(43), 4153–4154.
Nikolaus A, Christoph M, Dagmar B, et al.Optimal septum alignment of the Figulla Flex occluder to the atrial septum in patients with secundum atrial septal defects.EuroIntervention 2016;11(10):1153-60
Transcatheter atrial septal defect (ASD) occlusion. In. Mullins CE. Cardiac catheterization in congenital heart disease: pediatric and adult. Massachusetts: Blackwell Futura; 2006, pp.728-79.
ASD device closure. In. Bergersen L, Foerster S, Marshall AC, Meadows J. eds. Congenital heart dise. The catheterization manual. Springer; 2009, pp.115-8.
El-Said H, Hegde S, Foerster S, et al. Device therapy for atrial septal defects in a multicenter cohort: acute outcomes and adverse events. Catheter Cardiovasc Interv 2015; 85:227
Braun MU, Fassbender D, Schoen SP, et al. Transcatheter closure of patent foramen ovale in patients with cerebral ischemia. J Am Coll Cardiol 2002; 39:2019.
Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 115 published online April 19, 2007.
Calvert PA, Rana BS, Kydd AC, Shapiro LM. Patent foramen ovale: anatomy, outcomes, and closure. Nat Rev Cardiol 2011;8:148–60. https://doi.org/10.1038/nrcardio.2010.224; PMID: 21283148.
Venturini JM, Retzer EM, Estrada JR, et al. A practical scoring system to select optimally sized devices for percutaneous patent foramen ovale closure. J Struct Hear Dis 2016;2:217–23. https://doi.org/10.12945/j.jshd.2016.009.15; PMID: 29104878.
Pristipino C, Sievert H, D'Ascenzo et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eur Heart J. 2019 Oct 7;40(38):3182-3195.
Referanslar
Van der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011;58:2241-7.
Helmut BA, Julie De BA, Sonya V. Et al. 2020 ESC Guidelines for the management of adult congenital heart disease. European Heart Journal 2021; 42; 563-645
Kotowycz MA, Therrien J, Ionescu-Ittu R, et al. Long-term outcomes after surgical versus transcatheter closure of atrial septal defects in adults. JACC Cardiovasc Interv 2013; 6:497.
Butera G, Biondi-Zoccai G, Sangiorgi G, et al. Percutaneous versus surgical closure of secundum atrial septal defects: a systematic review and meta-analysis of currently available clinical evidence. EuroIntervention 2011; 7:377.
Baumgartner, H., & De Backer, J. (2020). The ESC Clinical Practice Guidelines for the Management of Adult Congenital Heart Disease 2020. European heart journal, 41(43), 4153–4154.
Nikolaus A, Christoph M, Dagmar B, et al.Optimal septum alignment of the Figulla Flex occluder to the atrial septum in patients with secundum atrial septal defects.EuroIntervention 2016;11(10):1153-60
Transcatheter atrial septal defect (ASD) occlusion. In. Mullins CE. Cardiac catheterization in congenital heart disease: pediatric and adult. Massachusetts: Blackwell Futura; 2006, pp.728-79.
ASD device closure. In. Bergersen L, Foerster S, Marshall AC, Meadows J. eds. Congenital heart dise. The catheterization manual. Springer; 2009, pp.115-8.
El-Said H, Hegde S, Foerster S, et al. Device therapy for atrial septal defects in a multicenter cohort: acute outcomes and adverse events. Catheter Cardiovasc Interv 2015; 85:227
Braun MU, Fassbender D, Schoen SP, et al. Transcatheter closure of patent foramen ovale in patients with cerebral ischemia. J Am Coll Cardiol 2002; 39:2019.
Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 115 published online April 19, 2007.
Calvert PA, Rana BS, Kydd AC, Shapiro LM. Patent foramen ovale: anatomy, outcomes, and closure. Nat Rev Cardiol 2011;8:148–60. https://doi.org/10.1038/nrcardio.2010.224; PMID: 21283148.
Venturini JM, Retzer EM, Estrada JR, et al. A practical scoring system to select optimally sized devices for percutaneous patent foramen ovale closure. J Struct Hear Dis 2016;2:217–23. https://doi.org/10.12945/j.jshd.2016.009.15; PMID: 29104878.
Pristipino C, Sievert H, D'Ascenzo et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eur Heart J. 2019 Oct 7;40(38):3182-3195.
