Page 12 - Journal of Structural Heart Disease Volume 4, Issue 3

Original Scienti c Article
Journal of Structural Heart Disease, June 2018, Volume 4, Issue 3:69-78
DOI: https://doi.org/10.12945/j.jshd.2018.039.17
Received: September 12, 2017 Accepted: October 27, 2017 Published online: June 2018
Predictors of Procedure Time Prolongation During Percutaneous Transcatheter Closure of Atrial Septal Defect - A Retrospective Study Milad El-Segaier, MD, PhD1*, Shehla Jadoon, MD1, Tariq Javid, MD1,
Tariq A Wani, M. Sc. Statistics2, Mohammed Omar Galal, MD, PhD, MBA3
1 Department of Pediatric Cardiology, King Fahad Medical City, KSHC, Riyadh, Saudi Arabia
2 Clinical and Translational Research Department, King Fahad Medical City, Riyadh, Saudi Arabia
Abstract
Background: Percutaneous transcatheter closure (PTCC) of atrial septal defect (ASD) may convert to a long procedure. We aimed to identify predictors of pro- longed procedure.
Methods: Under transesophageal echocardiography and uoroscopy guidance, 81 children with ASD un- derwent PTCC. Retrospectively, medical charts, echo- cardiographic recordings, catheterization reports and uoroscopic lms were reviewed. Demographics, echocardiographic measurements of ASD, dimensions of the device and hemodynamic data were collected. Prolonged procedure was de ned as the duration from device deployment out of the delivery sheath to its release exceeding 10 minutes. A statistical model was designed using stepwise logistic regression analysis. Receiver operating characteristic curves were plotted to nd the best cut-o for signi cant predictors. Results: The procedure was prolonged in 25 patients. By monovariate analysis, the signi cant predictors for prolonged procedure were smaller, and younger pa- tients, larger ASD, smaller left atrial (LA) dimensions and device waist ratios to weight, patient’s length, and LA dimensions. By multivariate analysis, the signi cant predictors were de cient septal rim toward superior vena cava (SVC) and device waist diameter in relation to patient’s length (best cut-o : < 12 mm and > 0.13, re- spectively). In three cases (3.7%) the device embolized; retrospectively possibly the cause is small used device
and in one combined with vigorous physical activity. Conclusions: A short septal rim toward superior vena cava and large device waist size in relation to patient size and/or LA dimensions may predict prolonged pro- cedure during PTCC of ASD.
Copyright © 2018 Science International Corp.
Key Words
ASD closure • Pediatric intervention • Transcatheter embolization • Congenital heart disease • Statistical analysis • Intervention of structural heart disease
Introduction
Percutaneous Transcatheter Closure (PTCC) is the current preferred treatment option for secundum atrial septal defect (ASD) [1]. The advantages of cur- rently used devices include relatively easy deploy- ment, easy retrievability, and the ability to close even large and fenestrated defects [2-5]. Contraindications of PTCC are elevated pulmonary vascular resistance and acute infections.
During the PTCC of ASD, sometimes the procedure may get unduly prolonged. The causes for such pro- longation and the potential of procedure failure are related to the patient variables (clinical situation, de- mographics of the patient, etc.) or to the cardiac or
* Corresponding Author:
Milad El-Segaier, MD, PhD
Department of Pediatric Cardiology
King Fahad Medical City, KSHC
Mecca Road, Riyadh, Saudi Arabia
Tel. +966 50 698 9958; Fax: +9662889999 (ext:11113); E-Mail: mail4milad@gmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISN 2326-4004
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