Atrial septal defect (ASD) is a hole in the muscular wall (interatrial septum) between the two upper chambers of the heart (atrium). Such deficiency leads to communication between both atria, which, if sufficiently large, can lead to a reversal of blood flow and consequently to many disorders such as heart failure, pulmonary hypertension, stroke, heart rhythm disturbances.
It is one of the most common congenital heart defects. There are many forms of defect, but the most common is the so-called type secundum, in which the described communication is located at the very middle of the septum.
Diagnosis is often made during adulthood because patients have no symptoms or have minimal symptoms.
For the last several decades, the treatment has been purely surgical, but today the method of percutaneous defect closure is being used with the help of so-called occluder, which is also available at our institution since 2018.
Prior to the procedure, each patient is fully explained the benefits and potential risks of the procedure (informed consent of the patient). It should be noted that before and after the procedure, it is mandatory to take dual anti-aggregation therapy (acetylsalicylic acid plus clopidogrel) for a minimum of 3 months, due to the risk of thrombosis of the device. Prophylaxis of bacterial endocarditis is also required up to 6 months after surgery.
As part of the preparation for the procedure, a transesophageal ultrasound (TEE) is performed to determine in more detail the characteristics of the septal defect itself for better planning of the intervention (type of defect, size, anatomic borders). The same method excludes the existence of a thrombus in the left atrial appendage.
The procedure is performed by introducing a catheter via the groin vein, with previous local anesthesia of the injection site and intravenous titration of the analgosedation. The catheter is then placed first through the vein into the right atrium and then through the atrial septal defect into the left atrium. An ultrasound probe (TEE) is also placed in the esophagus during the procedure, through which the optimum position of the occluder can be clearly visualized, as well as early complications of procedure (alternatively, an intracardiac ultrasound can be placed via another groin vein).
When the sheath is positioned in an adequate anatomic location, the occluder is slowly released until it ‘sits’ on the septum defect. The septal occluder use din our center consists of two disks composed of nitinol and polyester, which are interconnected by a short central part that completely fills the defect. The very composition of the occluder enhances the process of closing the defect in such a way that in the weeks after the procedure it stimulates the device to grow into cardiac tissue, which definitely closes the defect.
The success rate of the procedure is extremely high (98% successfully closed ASD 12 months after the procedure) with a low risk of complications (<1%).
The day after the procedure, a control transthoracic ultrasound of the heart is performed, and it should be repeated within the control monitoring 3 months after the procedure.
The patient is most often discharged home day after the procedure if the postprocedural course is uneventful.
Atrial septal defect (ASD) ni upungufu katika ukuta wa misuli (interatrial septum) kati ya vyumba viwili vya juu vya moyo (atrium). Ukosefu huo husababisha mawasiliano kati ya atria zote mbili, ambayo, ikiwa kubwa vya kutosha, inaweza kusababisha kubadilika kwa mtiririko wa damu na kwa hivyo kusababisha matatizo mengi kama vile kushindwa kwa moyo, shinikizo la damu la mapafu, kiharusi, matatizo ya moyo. Ni mojawapo ya kasoro za moyo za kuzaliwa zinazopatikana kwa ukawaida. Kuna aina nyingi za kasoro, lakini ya kawaida ni aina inayoitwa secundum, ambayo mawasiliano yaliyoelezwa iko katikati kabisa ya septum. Mara nyingi ugonjwa huo hugunduliwa wakati wa utu uzima kwa sababu wagonjwa hawana dalili zozote au wana dalili chache tu. "Kwa miaka kadhaa iliyopita, matibabu yalikuwa ya upasuaji tu, lakini leo mbinu ya kufungwa kwa kasoro ya ngozi inatumika kwa msaada wa kile kinachoitwa ""occluder,"" ambayo pia inapatikana katika taasisi yetu tangu 2018." Kabla ya utaratibu, kila mgonjwa anaelezwa kikamilifu faida na hatari zinazowezekana za utaratibu (kubali kwa habari ya mgonjwa). Kabla ya matibabu, ni lazima kuchukua dawa mbili za kuzuia mkusanyiko (acetylsalicylic acid na clopidogrel) kwa angalau miezi mitatu, kwa sababu ya hatari ya thrombosis ya kifaa. Ugonjwa wa endocarditis ya bakteria pia unahitaji kuhifadhiwa kwa miezi sita baada ya upasuaji. Katika mchakato wa upasuaji, ultrasound ya transesophageal (TEE) hufanywa ili kuamua kwa undani zaidi sifa za kasoro ya septal yenyewe kwa mipango bora ya uingiliaji (aina ya kasoro, ukubwa, mipaka ya anatomiki). Njia hiyohiyo haifanyi kuwepo kwa thrombo katika kiungo cha atrial cha kushoto. Utaratibu huo hufanywa kwa kuingiza catheter kupitia mshipa wa groin, na anesthesia ya awali ya mahali pa sindano na titration ya ndani ya mshipa wa analgosedation. Kisha catheter huwekwa kwanza kupitia mshipa wa damu ndani ya atrium ya kulia na kisha kupitia kasoro ya septal ya atrium ndani ya atrium ya kushoto. Ultrasound probe (TEE) pia huwekwa katika esophagus wakati wa utaratibu, kupitia ambayo nafasi bora ya occluser inaweza kuonekana wazi, pamoja na matatizo ya mapema ya utaratibu (kwa njia nyingine, ultrasound ya ndani ya moyo inaweza kuwekwa kupitia mshipa mwingine wa groin). Wakati sheath ni nafasi katika nafasi ya kutosha anatomic, occluser ni polepole iliyotolewa mpaka ni <unk> anakaa <unk> juu ya kasoro septum. Septal occluser ni sehemu ya diski mbili zilizojengwa kwa nitinol na polyester, ambazo zimeunganishwa na sehemu fupi ya kati ambayo hujaza kabisa kasoro. Muundo wa occluser huongeza mchakato wa kufunga kasoro hiyo kwa njia ambayo katika wiki baada ya utaratibu huchochea kifaa kukua katika tishu ya moyo, ambayo kwa hakika hufunga kasoro hiyo. Ufanisi wa matibabu ni wa juu sana (asilimia 98 ya matibabu ya ASD imefungwa kwa mafanikio miezi 12 baada ya utaratibu) na hatari ya chini ya matatizo (< 1%). Siku moja baada ya utaratibu, ultrasound ya moyo ya transthoracal ya udhibiti hufanywa, na inapaswa kurudia ndani ya ufuatiliaji wa udhibiti miezi mitatu baada ya utaratibu. Mara nyingi mgonjwa hutolewa nyumbani siku moja baada ya utaratibu ikiwa mchakato wa baada ya utaratibu hauna matukio.