1 . 2024

Results of endovascular treatment of multiple atrial septal defects with septal aneurysm in childhood

Tarasov R.S.

Abstract

Background. Transcatheter closure of atrial septal defects has become a successful alternative to open surgery over the past three decades. The most complex morphological form is represented by multiple defects with aneurysmal altered septum.

Aim – to study the early and long-term results of endovascular closure of multiple atrial septal defects.

Material and methods. A retrospective, cohort, non-randomized study of 54 patients under 18 years of age was conducted. The age at the time of the intervention was 5.75 [3; 8] years, weight 21.1 [12.5; 22] kg, height 109.42 [90; 128] cm. All patients were implanted with Nit-Occlude PFO occluders with sizes: 20, 26, 30 mm. The procedure time was 32.27 [20; 40] min. Echocardiographic parameters were evaluated before surgery, in the postoperative period, after 3 months and in the long-term follow-up period. The compared indicators were checked for the normality of the data distribution by the Kolmogorov –Smirnov test and Shapiro-Wilk test tests – all indicators did not correspond to the law of normal distribution; therefore, nonparametric methods of statistical analysis were used. The data was evaluated using nonparametric statistical methods – Freedman ANOVA test, Wilcoxon test with Holm–Bonferroni correction. Statistically significant differences were considered at p<0.05. The analysis of freedom from re-operation is reflected in the Kaplan–Meier plot.

Results. 3 (5.5%) patients required repeated open surgery. In the early postoperative period, insignificant atrial shunts were detected in the area of the device installation in 13 (24.1%) cases. According to echocardiography, in the early postoperative period, the size of the right ventricle significantly decreased to 2.33 [1.56; 2.78] cm/m2 (p=0.005). In dynamics from 3 to 6 months, the left ventricular ESS decreased to 2.76 [2.1; 3.26] cm/m² (p=0.001). A decrease in the volume load on the right chambers led to a decrease in the size of the right ventricle to 1.71 [1.24;2.05] cm/m²(p=0.0005) and the length and width of the right atrium to 3.51 [2.7; 4.17] cm/m2 and 3.62 [2.55; 4.51] cm/m² (p=0.0001, p=0.00003) respectively. In the long-term postoperative period, the EDS of the left ventricle decreased to 4.15 [3.4;4.78] cm/m² (p=0.0005), ESS to 2.55 [2.09; 2.88] cm/m² (p=0.004). The width of the right atrium decreased to 3.28 [2.82; 3.72] cm/m² (p=0.002). The size of the left atrium decreased to 2.78 [2.2; 3.23] cm/m² (p=0.04), the size of the right ventricle to 1.58 [1.26; 1.87] cm/m² (p=0.024).

Conclusion. Percutaneous closure of multiple atrial septal defects is effective with a minimum number of postoperative complications. A thorough analysis and assessment of morphology is mandatory to select the appropriate device and the optimal strategy. There is also a positive remodeling of the heart chambers after the restoration of physiological hemodynamics.

Keywords:congenital heart defects; multiple atrial septal defects; endovascular interventions

Funding. The work was carried out with the support of a comprehensive program of fundamental scientific research of the Russian Academy of Sciences within the framework of the fundamental theme of the Scientific Research Institute of the Communist Party of the Soviet Union No. 0419-2022-0003 “Development of new medical devices for cardiovascular surgery. The transition to personalized medicine and high-tech healthcare. Creation of systems for processing large volumes of data, machine learning and artificial intelligence”.

Conflict of interest. The authors declare no conflict of interest.

For citation: Tarasov R.S., Troshkinev N.M. Results of endovascular treatment of multiple atrial septal defects with septal aneurysm in childhood. Clinical and Experimental Surgery. Petrovsky Journal. 2024; 12 (1): 98–106. DOI: https://doi.org/10.33029/2308-1198-2024-12-1-98-106 (in Russian)

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