背景:虽然在当今时代不太常见,继发性房间隔缺损(ASD2)的手术闭合在某些临床情况下仍可进行。目前,指南建议对接受外科ASD2封堵术的患者进行经胸超声心动图(TTE)的终身随访。这项研究的目的是确定随访TTE在接受无并发症ASD2封堵的患者中的实用性。
方法:对1996年4月1日至2021年8月30日之间进行手术ASD2闭合的患者进行了图表回顾。如果患者患有其他先天性心脏病,则将其排除在外,诊断为残留的ASD2,房性/室性心律失常,肺动脉高压,心力衰竭,或在手术后6个月没有随访TTE。评估了最新的TTE和临床记录。
结果:共有30名患者符合标准。ASD2手术的中位年龄为4.0岁(IQ;1.9-10.5)。16例患者通过补片修复闭合ASD2,14例患者主要闭合。最近一次TTE在ASD2封堵后平均9.5年(IQ;4.0,14.7)进行。两名患者右心房和心室轻度扩张,一名患者右心房轻度扩张,1例患者右心室轻度扩张。所有其他患者的右侧腔室尺寸定性正常。所有患者的双心室功能均正常(左心室缩短分数(中位数36%(IQ;33,42)),没有残余心房分流的证据,也没有肺动脉高压的证据.在上次临床就诊时,没有患者服用任何心脏药物。4例患者从心脏病学门诊出院,10例患者失访。没有死亡。24例患者在ASD2术后1年以上有46例重复超声心动图,临床管理没有变化。
结论:在接受简单ASD2封堵的患者中,在随访的TTEs上没有发现明显的异常.需要重复寿命TTE及其频率,在这个简单的人口中,如果随访时间较长的大型研究证实了这些初步发现,则应重新评估.
BACKGROUND: Though less common in the current era, surgical closure of secundum atrial septal defects (ASD2) is still performed in certain clinical situations. Guidelines currently recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who have undergone a surgical ASD2 closure. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated ASD2 closure.
METHODS: Chart review was performed on patients who had a surgical ASD2 closure between April 1, 1996, and August 30, 2021. Patients were excluded if they had other congenital heart disease, had a diagnosis of a residual ASD2, atrial/ventricular arrhythmias, pulmonary hypertension, heart failure, or did not have a follow-up TTE > 6 months after the procedure. The most recent TTEs and clinic notes were evaluated.
RESULTS: A total of 30 patients met the criteria. The median age at ASD2 surgery was 4.0 years (IQ; 1.9-10.5). ASD2 was closed via patch repair in 16 patients and primarily closed in 14 patients. The most recent TTE was performed a median of 9.5 years (IQ; 4.0, 14.7) after ASD2 closure. Two patients had mild right atrial and ventricular dilation, one patient had mild right atrial dilation, and one patient had mild right ventricular dilation. All other patients had qualitatively normal right-sided chamber sizes. All patients had normal biventricular function (left ventricular fractional shortening (median 36% (IQ; 33, 42)), no evidence of residual atrial shunts, and no evidence of pulmonary hypertension. No patient was on any cardiac medications at last clinic visit. Four patients were discharged from cardiology clinic and 10 patients were lost to follow-up. There were no deaths. Twenty-four patients had 46 repeat echocardiograms > 1 year after ASD2 with no change in clinical management.
CONCLUSIONS: In patients who underwent an uncomplicated ASD2 closure, there were no significant abnormalities noted on follow-up TTEs. The need for repeat lifetime TTEs and their frequency, in this uncomplicated population, should be reassessed if larger studies with longer follow-up confirm these initial findings.