Dissertation for obtaining the scientific degree of candidate of medical sciences in the specialty 14.01.04 - cardiovascular surgery. - "National Amosov Institute of Cardiovascular Surgery, National Academy of Medical Sciences of Ukraine".
The dissertation contains a theoretical substantiation and a practical solution to a topical scientific task in the field of medicine – effectiveness and safety of secondary atrial septal defect endovascular closure increasing and expanding the indications for its interventional treatment by new techniques implementing considering the defects anatomy and patients clinical features.
The clinical material consisted of the results of 1,408 subsequent patient’s studies aged from 1.1 to 68 years, for the period from 2003 to 2022. According to the ASD anatomy variant, the examined patients were divided into 5 groups: group I consisted of 489 patients with a central defect (34.7%), group II included 580 patients with aortic rim deficiency (41.2%), group III consisted of 214 people who had multiple defects (15.2%), group IV included 107 patients with a defect in the septal aneurysm, group V was represented by 18 patients with superior/inferior and roof rim of the atrium deficiency (1.3%). The groups of examined cases did not differ among themselves, which allows us to consider the groups as representative and to minimize the value of the initial indicators when comparing the results of treatment. 1424 occluders from four different manufacturers were utilized in 1408 patients. Іn total (92.1%) occluders of classic form were used, in 6.0% of cases - with enlarged fields, and in 2.0% - multifenestrated. We determined that the average size of the occluder exceeded the average size of the central defect by 16.4%, with aortic rim deficiency - by 18.7%, and in the presence of an aneurysm of the interatrial septum - by 42.9%. The effectiveness of the procedure did not depend on the type of occluder for the manufacturer (p = 0.088). 8 methods and approaches to endovascular closure of ASD were developed and implemented in clinical practice. In 33.9% of the patients with the complex ASD anatomy, a modified technique of endovascular closure was applied when the standard technique was ineffective or impossible to use. The implemented clinical approaches made it possible to detect defects in patients with a clinically complicated course and children with a body weight below 10 kg. The procedure was successful in 98.7% cases: in 100% - with a central ASD and ASD with aortic rim deficiency, with multiple defects - 97.2%, with an ASD in an aneurysm - 98.1%, defects with superior/inferior and roof rim of the atrium deficiency - 44.5%. The rate of complications in the intra- and early postoperative period was 1.8%, among which the migration of the device was dominant. At the stage of learning curve one death was documented. The average follow-up period in our study was 5.41 ± 3.28 years (from 1 to 19 years), with the coverage of 94%. The rate of complications in the late follow-up was 1.3%, among which AF recurrence was dominant. The obtained results indicate the effectiveness and safety of the implementation of methods and approaches for the endovascular treatment of ASD. We managed to expand the indications for endovascular closure of ASD and develop an algorithm for choosing a treatment method for you with a defect of complex anatomy and with a clinically complicated course. Due to the implementation, we managed to reduce the percentage of rejections for diseases with an anatomic cause and with a clinically complicated course from 54% in 2009 to 8% in 2022.
The performed work is the first domestic research, study, and comparison of immediate and long-term results of endovascular closure of a secondary atrial septal defect with complex anatomy and a clinically complicated course.
Key words: congenital heart defects, atrial septal defect, occluder, pulmonary hypertension, atrial fibrillation, body weight below 10 kg.
