Immediate- and medium-term effects of simultaneous percutaneous corrections of secundum type atrial septal defect combined with pulmonary valve stenosis in local anesthesia and without transesophageal echocardiography guidance.
BACKGROUND
The feasibility and efficacy of simultaneous percutaneous treatment of secundum type atrial septal defect (ASD) combined with pulmonary valve stenosis (PS) have not been proved.


OBJECTIVE
To evaluate the safety and efficacy on the clinical benefit of simultaneous percutaneous correction of these two pathologies under local anesthesia and without transesophageal echocardiography guidance.


METHODS
Transpulmonary gradient, functional status, pulmonary regurgitation (PR), and tricuspid regurgitation (TR) were studied in 35 patients undergoing percutaneous balloon pulmonary valvuloplasty and ASD closure from March 2004 to July 2012. All patients were followed up until January 2013, an average of 39 months.


RESULTS
According to color Doppler transthoracic echocardiography (TTE) before the intervention, the ASD defect size and transpulmonary gradient were 17±8.4 mm and 88±37.8 mmHg, respectively. Post-interventionally, the peak-to-peak transpulmonary gradient decreased from 77±37.6 mmHg to 20±16.2 mmHg (p<0.001) and the ASD occluder size was 23±10.5 mm. In all those patients, there was no residual shunt detected, and moderate and severe TR decreased from 45.7% (16/35) and 20% (7/35) to 8.6% (3/35) and 5.7% (2/35) before and after intervention detected by TTE, respectively. Eight patients had mild PR after procedure and two of them recovered at 6 months and no patient encountered severe adverse events at the latest follow-up.


CONCLUSIONS
Simultaneous percutaneous corrections of ASD combined with PS are feasible, safe, and effective with satisfactory results.
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
Xu-Dong
XD
Xu
Cardiovascular Therapeutic Center of the 117 Hospital of the Chinese People's Liberation Army, Hangzhou 310007, PR China.
Xue-Yan
XY
Ding
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
Su-Xuan
SX
Liu
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China.
Yuan
Y
Bai
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China. Electronic address: xianxianz2010@163.com.
Xian-Xian
XX
Zhao
Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, PR China. Electronic address: qywsmmu@163.com.
Yong-Wen
YW
Qin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D063126:Balloon Valvuloplasty / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011666:Pulmonary Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D055989:Septal Occluder Device; D025321:Surgery, Computer-Assisted; D013995:Time; D016896:Treatment Outcome; D055815:Young Adult
Atrial septal defect; Combined cardiopathies; Congenital heart disease; Pulmonary stenosis; Transcatheter