Abstract：
Device closure has become the preferred procedure for treating oval fossa defects in the last two decades. More recently, transcatheter sinus venosus defect (SVD) closure has emerged as an alternative to surgery. Transcatheter stenting aims to overcome potential late surgical complications such as stenosis of the superior vena cava (SVC) and right upper pulmonary vein (RUPV), as well as sinus node dysfunction. Balloon interrogation of the cavoatrial junction is able to identify patients who are suitable candidates for nonsurgical closure. Successful closure is possible when the balloon seals the SVD and redirects the RUPV towards the left atrium. Oval fossa (secundum) defects can coexist in approximately 9-16% of patients with SVD. Among a group of 80 patients who underwent transcatheter closure of SVD, five adult patients aged between 22 and 52 years also required device closure of an associated oval fossa defect. The procedure involved simultaneous balloon interrogation of both the SVD and oval fossa defect, with continuous monitoring of the RUPV using bilateral femoral venous sheaths. Covered stent exclusion of the SVD was performed with concurrent device closure of the oval fossa defect using 12-36 mm atrial septal occluders. During the procedure, two patients required protective balloon inflation in the RUPV while expanding the covered stent. In one patient, a higher small accessory RUPV was intentionally left to drain into the SVC through the struts of a bare stent anchoring the covered stent in the upper SVC. In another patient, a second overlapping covered stent was used to address residual flows from a fabric tear that became apparent after balloon deflation. There were no vascular complications and only one patient exhibited an insignificant 6 mm residual flow from the caudal edge of the SVD during a follow-up of 5 to 72 months. In conclusion, the closure of both SVD and associated oval fossa defects can be successfully performed in a single procedure, with comparable procedural times and favourable mid-term outcomes.
摘要：
在过去的二十年中，设备闭合已成为治疗卵圆窝缺损的首选方法。最近,经导管静脉窦缺损（SVD）封堵术已成为手术的替代方法。经导管支架术旨在克服潜在的晚期手术并发症，例如上腔静脉（SVC）和右上肺静脉（RUPV）狭窄，以及窦房结功能障碍。腔静脉交界处的球囊询问能够确定适合非手术闭合的患者。当球囊密封SVD并将RUPV重定向到左心房时，成功的闭合是可能的。椭圆形窝（secundum）缺陷可以在大约9-16％的SVD患者中共存。在一组80例接受SVD导管封堵的患者中，五名年龄在22至52岁之间的成年患者也需要封堵相关的卵圆窝缺损。该程序涉及同时对SVD和卵圆窝缺损进行球囊询问，使用双侧股静脉鞘连续监测RUPV。使用12-36mm房间隔封堵器同时闭合卵形窝缺损，同时进行SVD的覆盖支架排除。在手术过程中,两名患者在扩张覆膜支架的同时需要在RUPV中进行保护性球囊充气。在一个病人中,有意将较高的小附件RUPV通过裸露支架的支柱排入SVC，该支架将覆膜支架固定在上SVC中。在另一个病人身上，我们使用了第二个重叠覆膜支架来解决球囊放气后出现的织物撕裂的残余流量.在5至72个月的随访中，没有血管并发症，只有一名患者从SVD的尾部边缘表现出微不足道的6mm残余流量。总之,SVD和相关的卵圆窝缺损的闭合可以在一个过程中成功完成，具有可比的程序时间和有利的中期结果。
