Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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이차공 심방 중격 결손의 폐쇄: 경피적 방법과 수술적 방법의 비교

Closure of secundum atrial septal defect: comparison between percutaneous and surgical occlusion

  • 김나연 (가천의과학대학교 소아과학교실) ;
  • 권현정 (가천의과학대학교 소아과학교실) ;
  • 최덕영 (가천의과학대학교 소아과학교실) ;
  • 정미진 (가천의과학대학교 소아과학교실) ;
  • 최창휴 (가천의과학대학교 흉부외과학교실) ;
  • 김성호 (한라병원 소아과)
  • Kim, Na Yeon (Department of Pediatris, Gil Medical Center, Gachon University of Medicine) ;
  • Kwon, Hyun Jung (Department of Pediatris, Gil Medical Center, Gachon University of Medicine) ;
  • Choi, Deok Young (Department of Pediatris, Gil Medical Center, Gachon University of Medicine) ;
  • Jung, Mi Jin (Department of Pediatris, Gil Medical Center, Gachon University of Medicine) ;
  • Choi, Chang Hyu (Department of Thoracic and Cardiovascular Surgery, Gil Medical Center, Gachon University of Medicine) ;
  • Kim, Seong Ho (Department of Pediatrics, Halla General Hospital)
  • 투고 : 2007.02.06
  • 심사 : 2007.04.10
  • 발행 : 2007.05.15
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초록

목 적 : 이차공 심방 중격 결손의 Amplatzer 기구를 이용한 경피적 폐쇄의 안정성, 효용성 및 임상 결과를 수술적 폐쇄법과 비교하기 위하여 본 연구를 시행하였다. 방 법 : 2000년 1월부터 2006년 6월까지 가천의과학대학교 길병원에서 이차공 심방 중격 결손으로 진단 받은 환자 115명을 대상으로 하였다. 그 중 70명에게 결손의 수술적 폐쇄술을 시행하였고, 45명의 환자에게 Amplatzer 기구를 이용한 경피적 폐쇄술을 시행하였다. 수술군과 시술군의 사망율, 합병증, 입원기간과 효용성을 조사하여 결과를 비교분석하였다. 결 과 : 전체 남녀 비는 1:2.4였다. 두 환자군에서 평균 연령과 결손크기는 유의한 차이가 없었다. 성공율은 시술군에서 97.8%, 수술군에서 100%였다. 전체 합병증은 수술군에서 시술군보다 많이 발생하였다(64.0 vs. 15.6%, P<0.05). 입원기간은 시술 군이 수술군보다 짧았다($4.2{\pm}1.2$ vs. $12.4{\pm}4.7days$, P<0.0001). 잔류단락은 시술군(8.9%)에서 수술군(4.3%)에 비해 더 많이 발생하였는데, 3개월후 추적 검사에서는 모두 소실되었다. 결 론 : 이차공 심방 중격 결손증의 Amplatzer 기구를 이용한 경피적 폐쇄는 수술을 대체할 수 있는 안전하고 효과적인 방법이다. 경험이 축적되고 기구가 발전하면서 경피적 폐쇄술의 적용 범위가 점차 확대되고 있다.

Purpose : This study was performed to compare the safety, efficacy and clinical results of the Amplatzer septal occluder (ASO) for closure of secundum atrial septal defect (ASD) with surgery. Methods : One hundred fifteen patients diagnosed as isolated secundum ASD in Gil Medical Center, Gachon University of Medicine from January 2000 to July 2006 were included. Seventy patients underwent surgical repair of ostium secundum ASD. Forty-five consecutive patients were treated with percutaneous closure using ASO. We compared the mortality, morbidity, hospital stay, and efficacy between two groups. Results : Male to female ratio was 1:2.4. The mean age and the size of defects were not statistically different. No mortality occurred in either group. The success rate was 97.8% in the device group and 100% in the surgical group. The overall rate of complications was higher in the surgical group than in the device group (64.0 vs. 15.6%, P<0.05). Hospital stay was shorter in the device group than in the surgical group ($4.2{\pm}1.2$ vs. $12.4{\pm}4.7days$, P<0.0001). Residual shunt rates were more frequent in the device group (8.9%) than in the surgical group (4.3%) at discharge. All residual shunts disappeared at 3 months follow-up. Conclusion : Percutaneous closure of ASD using ASO is a safe and effective alternative to surgical repair. The indications of percutaneous ASD closure with ASO would be expanded by accumulation of experiences and evolutions of device.

키워드

참고문헌

  1. Hoffman JI, Christianson R. Congenital heart disease in a cohort of 19,502 births with long-term follow-up. Am J. Cardiol 1978;42:641-7 https://doi.org/10.1016/0002-9149(78)90635-5
  2. Rigby ML. The era of transcatheter closure of atrial septal defects. Heart 1999;81:227-8
  3. King TD, Thompson SL, Steiner C, Mills NL. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA 1976;235:2506-9 https://doi.org/10.1001/jama.235.23.2506
  4. Masura J, Gabora P, Formanek P, Hijazi ZM. Transcatheter closure of secundum atrial septal defects using the new self-centering amplatzer septal occluder: initial human experience. Cathet Cardiovasc Diagn 1997;42:388-93 https://doi.org/10.1002/(SICI)1097-0304(199712)42:4<388::AID-CCD7>3.0.CO;2-7
  5. Bialkowski J, Karwot B, Szkutnik M. Closure of atrial septal defects in children: Surgery versus amplatzer device implantation. Tex Heart Inst J 2004;31:220-3
  6. Butera G, Carminati M, Chessa M, Youssef R, Drago M, Giamberti A, et al. Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications. Am Heart J 2006;151:228-34 https://doi.org/10.1016/j.ahj.2005.02.051
  7. Jo SS, Han SJ, Jung MJ, Lee SJ, Seol KH, Kim GH, et al. Transcatheter closure of atrial septal defect using amplatzer septal occluder. Korean Circulation J 2002;32:17-24 https://doi.org/10.4070/kcj.2002.32.1.17
  8. Murphy JG, Gersh BJ, McGoon MD, Mair DD, Porter CJ, Ilstrup DM, et al. Long term outcome after surgical repair of isolated atrial septal defect: follow up at 27 to 32 years. N Engl J Med 1990;323:1645-50 https://doi.org/10.1056/NEJM199012133232401
  9. Galal MO, Wobst A, Halees Z. Peri-operative complications following surgical closure of atrial septal defect type II in 232 patients: a baseline study. Eur Heart J 1994;15:1381-4 https://doi.org/10.1093/oxfordjournals.eurheartj.a060398
  10. Kalmar P, Irrgang E. Cardiac surgery in the Federal Republic of Germany during 1990: a report by the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 1991;39:167-9 https://doi.org/10.1055/s-2007-1013956
  11. Prieto LR, Foreman CK, Cheatham JP, Latson LA. Intermediate-term outcome of transcatheter secundum atrial septal defect closure using the Bard clamshell septal umbrella. Am J Cardiol 1996;78:1310-2 https://doi.org/10.1016/S0002-9149(96)00620-0
  12. Berger F, Ewert P, Bjornstad PG, Dahnert I, Krings G, Brilla-Austenat I, et al. Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer septal occluder. Cardiol Young 1999;9:468-73
  13. Choi JY. Recent advances in transcatheter treatment of congenital heart disease. Korean J Pediatr 2006;49:917-29 https://doi.org/10.3345/kjp.2006.49.9.917
  14. Berger F, Vogel M, Alexi-Meskishvili V, Lange PE. Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg 1999;118:674-80 https://doi.org/10.1016/S0022-5223(99)70013-9
  15. Rome JJ. Pediatric interventional catheterization: reasonable expectations and outcomes. Pediatr Clin North Am 2004; 51:1589-610 https://doi.org/10.1016/j.pcl.2004.08.007
  16. Formigari R, Di Donato RM, Mazzera E, Carotti A, Rinelli G, Parisi F, et al. Minimally invasive or interventional repair of atrial septal defects in children: experience in 171 cases and comparison with conventional strategies. J Am Coll Cardiol 2001;37:1707-12 https://doi.org/10.1016/S0735-1097(01)01213-X
  17. Thompson JD, Aburawi EH, Watterson KG, Van Doorn C, Gibbs JL. Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart 2002;87:466-9 https://doi.org/10.1136/heart.87.5.466
  18. Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K; Amplatzer Investigators. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults. J Am Coll Cardiol 2002;39:1836-44 https://doi.org/10.1016/S0735-1097(02)01862-4
  19. Kirklin JW, Barrat-Boyes BG. Cardiac surgery 2nd edition 1993 New York: Churchill Livingstone:609-44
  20. Krumsdorf U, Ostermayer S, Billinger K, Trepels T, Zadan E, Horvath K, et al. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol 2004;43:302-9 https://doi.org/10.1016/j.jacc.2003.10.030
  21. Meijboom F, Hess J, Szatmari A, Utents EM, McGhie J, Deckers JW, et al. Long-term follow-up (9 to 20 years) after surgical closure of atrial septal defect at a young age. Am J Cardiol 1993;72:1431-4 https://doi.org/10.1016/0002-9149(93)90192-F
  22. Bialkowski J, Karwot B, Szkutnik M, Sredniawa B, Chodor B, Zeifert B, et al. Comparison of heart rate variability between surgical and interventional closure of atrial septal defect in children. Am J Cardiol 2003;92:356-8 https://doi.org/10.1016/S0002-9149(03)00648-9
  23. Lee HJ. Transcatheter intervention of Congenital Heart Disease: current status in Korea with special comment on the device closure of atrial septal defect. Korean Circulation J 2002;32:15-6 https://doi.org/10.4070/kcj.2002.32.1.15
  24. Chessa M, Carminati M, Butera G, Bini RM, Drago M, Rosti L, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol 2002;39:1061-5 https://doi.org/10.1016/S0735-1097(02)01711-4
  25. Bourdages M, Piette E, Dahdah N, Miro J. Incidence of headaches after ASD percutaneous catheter closure with Amplatzer device (abstract). Catheter Cardiovasc Interv 2002;7:106
  26. Chan KC, Godman MJ, Walsh K, Wilson N, Redington A, Gibbs JL. Transcatheter closure of atrial septal defect and interatrail communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience. Heart 1999;82:300-6
  27. Berdat PA, Chatterjee T, Pfammatter JP, Windecker S, Meier B, Carrel T. Surgical managemen of complications after closure of an atrial septal or patient foramen ovale. J Thorac Cardiovac Surg 2000;120:1034-9 https://doi.org/10.1067/mtc.2000.111054
  28. Preventza O, Sampath-Kumar S, Wasnick J, Gold JP. Late cardiac perforation following transcatheter atrial septal defect closure. Ann Thorac Surg 2004;77:1435-7.- https://doi.org/10.1016/S0003-4975(03)00901-9
  29. Aggoun Y, Gallet B, Acar P, Pulik M, Czitrom D, Lagier A, et al. Perforation of the aorta after percutaneous closure of an atrial septal defect with acute severe hemolysis. Arch Mal Coeur Vaiss 2002;95:479-82
  30. Chun DS, Turrentine MW, Moustapha A, Hoyer MH. Development of aorta-to-right atrial fistula following closure of secundum atrial septal defect using the Amplatzer septal occluder. Catheter Cardiovasc Interv 2003;58:246-51 https://doi.org/10.1002/ccd.10434
  31. Lim HG, Lee CH, Seo HJ, Kim CW, Kim JS. Fistula of ascending aorta and right atrium following percutaneous transcatheter atrial septal defect closure, Korean J Thorac Cardiovasc Surg 2006;39:150-3
  32. Marcus WR, Christoph K, Hans-Jurgen R, Hintereder G, Hafner G, Meyer J. Clinical investigation: valvular and congenital heart disease, nickel relase after implantation of the Amplatzer occluder, Am Heart J 2003;145:737-41 https://doi.org/10.1067/mhj.2003.7
  33. Rome JJ, Keane JF, Perry SB, Spevak PH, Lock JE. Double-umbrella closure of atrial septal defects: initial clinical applications. Circulation 1990;82:751-8 https://doi.org/10.1161/01.CIR.82.3.751
  34. Horvath KA, Burke RP, Collins JJ Jr, Cohn LH. Surgical treatment of adult atrial septal defect: early and long term results. J Am Coll Cardiol 1992;20:1156-9 https://doi.org/10.1016/0735-1097(92)90372-T
  35. Choi JY. Recent advances in transcatheter treatment of congenital heart disease. Korean J Pediatr 2006;49:917-29 https://doi.org/10.3345/kjp.2006.49.9.917
  36. Lopez K, Dalvi BV, Balzer D, Bass JL, Momenah T, Hijazi ZM., et al. Transcatheter closure of large secundum atrial septal defects using the 40 mm Amplatzer septal occluder: results of an international registry. Catheter Cardiovasc Interv 2005;66:580-4 https://doi.org/10.1002/ccd.20468