Therapeutic Effect Of Pre-windowed Atrial Septal Defect Occluder In The Treatment Of Atrial Septal Defect With Severe Pulmonary Hypertension

Objective:To Evaluate the clinical feasibility and effectiveness of transcatheter closure of atrial septal defects（ASD）with severe pulmonary arterial hypertension（PAH）by fenestrated septal occluder.Methods:In recent years,transcatheter closure surgery have provided more options for the closure of atrial septal defects（ASD）with severe pulmonary arterial hypertension（PAH）.From January 2017 and March 2020, according of willing of patients and criteria of ASD transcatheter closure,25 patients were divided into two groups,One group was targeted drugs（13 cases）,another group was fenestrated occluder+targeted drugs（12 cases）.12 patients of ASD with severe PAH were received transcatheter closure using fenestrated occluder.All of patients,8patients were male,17 patients were female.Their mean age was 52.3 years（range 43-～66 years）.24 of patients were followed up 12 months.All patients had transthoracic echocardiography（TTE）at 1 weeks,3 months,6 months,12 months.Results:（1）The data of clinical and TTE did not reach statistical significance（P>0.05）. （2）The patients of targeted drugs were followed up 12 months,except one died by sudden death.After 6 months and 12 months,RAD（right atrial diameter）was 62.6±5.1mm and RVEDD（Right ventricular end-diastolic diameter）was 52.2±4.0 mm were increased statistical significantly（P<0.05）.（3）The measured systolic pulmonary artery pressure（s PAP）of 79.7±9.3 mm Hg was decreased to 64.3±7.1 mm Hg,64.6±6.7mm Hg,63.9±5.9 mm Hg,63.6±7.6 mm Hg,60.8±5.3 mm Hg at once,at 1 week,at 3months,6 months,12 months,which reach statistical significance compared of preoperation（P<0.05）.12 patients of fenestrated occluders group,who were safely and successfully given interventional closure.After fenestrated ASD occlusion,the symptomatic of patients were improved.Sa O₂（oxygen saturation）had recoveried more than 2-～4%（88%～91%increase 92%～95%）.The hole of the fenestrated ASD occluder had closed in 2 patient,10 patients were showed that the fenestrated ASD occluder had blood left to right.One ASD with AF（atrial fibrillation）was seen to have resumed after 12 months.（4）The measured RAD of 40.8±4.3 mm（at 6 months）and37.5±3.5 mm（at 12 months）were decreased,comparing of 52.2±5.7mm,51.1±5.2 mm,49.3±4.8 mm at once,at 1 week,at 3 months,which reach statistical significance （P<0.05）.The measured RVEDD of 37.1±3.5mm（at 6 months）and 36.4±3.3 mm（at 12months）were decreased,comparing of 36.4±3.3 mm,43.3±5.0 mm,43.1±4.8 mm at once,at 1 week,at 3 months,which reach statistical significance（P<0.05）.The measured LVEDD of 41.5±3.4 mm（at 6 months）and 43.8±3.6 mm（at 12 months）were increased,comparing of 33.5±4.2 mm,33.5±4.2 mm,34.2±3.9 mm at once,at 1 week,at 3 months,which reach statistical significance（P<0.05）.Conclusion:（1）for the patients with ASD who develop severe PAH,after fenestrated ASD occlusion,which can reduce the blood flow and pressure of pulmonary artery and improve the symptomatic of patients.The measured RAD and RVEDD decrease significantly after fenestrated ASD occlusion,The measured LVEDD increase significantly after fenestrated ASD occlusion.（2）For the patients with ASD who develop severe PAH,transcatheter ASD closure using fenestrated occluders is safe and effective.The short and middle term results are satisfactory.Postoperative cardiac and pulmonary function was significantly improved.But recovery was difficult and long process.We need strengthen the works of long term follow-up.