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D G Ioseliani1, I A Kovalchuk, T R Rafaeli
1Sechenov First Moscow State Medical University (Sechenov University).. fake@neicon.ru.
Insights
Simultaneous coronary artery stenting and atrial septal defect closure is a safe and effective combined endovascular procedure. This approach reduces hospital stay without increasing patient risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Atrial septal defect (ASD) and coronary artery disease (CAD) can coexist.
- Combined surgical or percutaneous treatment is complex.
- Assessing combined endovascular approaches is crucial.
Purpose of the Study:
- To evaluate the clinical efficacy and appropriateness of a single-stage, combined endovascular approach for coronary artery stenting and ASD closure.
- To determine the safety and feasibility of this combined procedure.
Main Methods:
- A retrospective analysis of 6 patients who underwent combined endovascular procedures.
- Procedures involved coronary stenting followed by ASD closure with an occluder.
- Transesophageal echocardiography and coronary angiography were used for assessment.
Main Results:
- Technical success rate was 100% for both coronary stenting and ASD closure.
- Complete ASD closure was achieved in 5 out of 6 patients immediately post-procedure.
- Significant reductions in right heart chamber volumes and pulmonary artery pressure were observed post-procedure.
- Exercise tolerance improved, and long-term defect closure was maintained.
Conclusions:
- Simultaneous coronary artery stenting and endovascular ASD closure is a safe and effective strategy.
- This combined approach does not increase patient risk and shortens hospital stay.
- It offers a viable option for patients with concomitant CAD and ASD.
Aim:
to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect.
Materials And Methods:
Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6 %) the procedure of endovascular repair of secondary ASD was combined with performed at same session oronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9.
Results:
At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100 %. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm3, right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm3, systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiography good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W.
Conclusion:
Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.