Abstract
Objective. To evaluate the role of echocardiography for the safe and successful endovascular closure of atrial septal aneurysm (ASA) in children.
Material and methods. To determine the technique, closure tactics, as well as the number and type of implanted devices, a detailed transthoracic echocardiography (TTE) was performed, which not only took into account the anatomical features of the ASA, but also determined the ratio of the length of the ASA to the base of the ASA. All children with ASA were divided into 3 groups depending on the number of defects in the ASA.
Results. Of the 91 patients, one defect in the ASA (group 1) occurred in 17 (18.7%) children, ASA with two defects (group 2) – in 33 (36.3%) patients, and multifenestrated ASA (group 3) – in 41 (45%) children. Patients in the 3 groups did not differ significantly in gender, age, and echocardiographic characteristics of ASA (p > 0.05). Successful correction of the defect was performed in 90 (98.9%) patients out of 91 children with ASA. 82 patients had one occlusion device implanted; 8 children required implantation of 2 occlusion devices. In 16 patients with multifenestrated ASA from group 3, all defects were closed using one device passed through a centrally located hole under echocardiography control; in 9 patients (6 from group 2 and 3 from group 3) with large defects and an ASA / total length of the septum ratio > 0.5 intraoperatively during echocardiography, the stop flow technique was used. One patient from group 3 failed to close the defects in the ASA using 2 devices, which required planned surgical correction under artificial circulation. Intraoperatively, thanks to echocardiography control, in 3 patients from group 3 with multifenestrated ASA, complications were avoided in time, which were successfully eliminated. Complete closure of the defect was observed in 74 (82.2%) patients immediately after the procedure; only 3 children had a slight defect at the last observation (observation period from 6 to 36 months, Me = 18 (Q1–Q3 = 6–36 months).
Conclusion. Our approach in dividing all patients with ASA by the number of defects according to TTE allows us to choose the right tactics for effective and safe transcatheter closure of ASA in children with excellent medium-term results. The incidence of complications in patients with multifenestrated ASA was higher than in other groups, which requires more thorough preoperative and intraoperative TTE assessment during endovascular correction of this defect.
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About the authors
- Mariya M. Kurako, Cand. Med. Sci., Functional Diagnostics Doctor, Ultrasonic Diagnostician; ORCID
- Manolis G. Pursanov, Dr. Med. Sci., Endovascular Surgeon; ORCID
- Mikhail A. Abramyan, Dr. Med. Sci., Professor of Chair of Pediatrics, Head of Department of Emergency Cardiac Surgery and Interventional Cardiology; ORCID
- Aleksey V. Bedin, Cardiovascular Surgeon; ORCID
