Journal of JCIC

Online edition: ISSN 2432–2342
JCIC学会事務局 JCIC学会事務局
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of JCIC 5(2): 19-23 (2021)


紐状構造物(strand)を支持力の一部として利用した経皮的心房中隔欠損閉鎖術Percutaneous Transcatheter Closure of Atrial Septal Defect Using Strand as a Part of the Supporting Margin

静岡県立こども病院 循環器科Department of Cardiology, Shizuoka Children’s Hospital

受付日:2020年5月27日Received: May 27, 2020
受理日:2021年1月29日Accepted: January 29, 2021
発行日:2021年3月25日Published: March 25, 2021

【背景】多孔性心房中隔欠損(multi-fenestrated atrial septal defect; MFASD)の類縁病変として1つの欠損孔が紐状構造物(strand)により,まれに2分割されることがあり,経皮的心房中隔欠損(atrial septal defect; ASD)閉鎖術の際に手技上の特別な配慮が必要となる.閉鎖術の際にstrandを支持力のある辺縁の一部として利用できる可能性とその効果について検討した.

【方法】当院で経験したASD症例のうち,経食道心エコー法でstrandを認めた8例を後方視的に検討した.最大幅3 mm以下の構造物をstrandと定義した.



【Background】In multi-fenestrated atrial septal defects (MFASD), one defect may rarely be divided into two due to a strand. Therefore, we should be careful during percutaneous transcatheter closure of atrial septal defects (ASD). We investigated the possibility and effects of using a strand as part of the supporting margin during a catheter intervention.

【Methods】This retrospective study included eight cases of ASD with a strand that were treated at our hospital. A structure with a maximum width of 3 mm or less was defined as a strand.

【Results】In all patients, the strands ran diagonally, and five patients had the main defect located in the antero-superior part. Five patients underwent transcatheter device closure and three patients underwent surgical closure. Under transesophageal echocardiography monitoring, we performed two-stage balloon sizing using the weak balloon sizing method where a slight shunt flow remains and the strong balloon sizing method which involves complete disappearance of the shunt flow and a slight balloon waist in the main defect. We then evaluated the compliance of the rim, including the strand. The closure devices were placed with reference to the strong balloon sizing method. Only one patient exhibited a small amount of residual shunt at the six months follow-up.

【Conclusion】The strand may act as a part of the margin for device closure. The defect position and deficient rim should be evaluated, in addition to the compliance of the supporting strand.

Key words: Atrial septal defect; multi-fenestrated; strand; Amplatzer Septal Occluder; Occulutech Figulla Septal Occluder

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