Recently, Beijing Friendship Hospital Affiliated to Capital Medical UniversityProfessor Chen Hui’s team Successfully completed transcatheter atrial septal defect closure for a 73-year-old female patient with congenital secondary foraminal atrial septal defect (ASD). The first application of the MemoCarna oxide film single-riveting ASD occluder in the hospital took only about 30 minutes! Since its official launch, the new domestically produced MemoCarna oxide film single-riveting ASD occluder has been clinically applied in many large medical centers in China, and has received unanimous praise and good surgical results; the perfect achievement of this surgical case not only further enriches The domestic evidence-based data of this occluder is obtained, and it is also another affirmation of the excellent performance of the MemoCarna oxide film single-riveting ASD occluder! After the operation, “Outpatient Clinic” specially invited Beijing Friendship Hospital Affiliated to Capital Medical UniversityProfessor Chen Hui To share the surgical insights and experience for this case, hoping to provide help for the majority of clinicians to understand and accept this new device.
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MemoCarna oxide film single-riveting ASD occluder
The patient was a 73-year-old female who complained of dizziness with visual rotation for more than 2 weeks. In-hospital physical examination showed: blood pressure 155/90 mmHg, clear language, horizontal nystagmus in both eyes, and the rest of the nervous system was inconclusive. positive signs. CT showed ischemic leukoencephalopathy near the frontal angle of the left ventricle and senile brain changes. After symptomatic drug treatment, the patient was not relieved. Considering the possibility of cerebral infarction, he was admitted to the Department of Neurology.
Subsequent series of examination results showed that the patient’s D-Dimer index was 1.01 μg/ml, the lower extremity vascular ultrasound showed thrombosis of the right calf intermuscular vein, and the TCD foaming test was positive (Grade IV). grade, massive shunt), consider the possibility of cardioembolism. Continued evaluation by transesophageal echocardiography showed that the size of the left atrial appendage was 1.4 cm×2.12 cm, and no thrombus was found in it. At the fossa ovalis of the interatrial septum, the echo loss was 0.78 cm×0.93 cm, with an area of about 0.55 cm², and there were left-to-right shunts.
The case was judged to be a congenital secondary foraminal atrial septal defect, and was then transferred to the structural heart department for treatment. After full communication with the patient and their family members, it was decided to perform transcatheter atrial septal defect closure surgery, and a 16 mm MemoCarna oxide film single-riveting ASD occluder was implanted.
Post-occluder imaging results
Postoperative echocardiographic assessment results
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Expert Comments｜Strengthen Disease Screening, Accurate and Efficient Intervention
MemoCarna oxide film single rivet ASD occluder
Professor Chen Hui:This is a relatively In a special case, the patient came to the emergency department of our hospital because of dizziness and visual rotation, and was transferred to the neurology department because of suspected cerebral infarction. Cause cerebral infarction. In fact, patients with small atrial septal defect in their 70s usually rarely undergo interventional treatment, but small atrial defect may be complicated by paradoxical embolism, and this complication is particularly common in The adult population is over 60 years old. Therefore, despite the patient’s advanced age, considering that this is a cerebral infarction caused by contradictory embolism, and there are clear indications for surgery, the team in our hospital finally chose after full communication with the patient’s family. The treatment plan of transcatheter atrial septal defect closure under the guidance of X-ray and ultrasound was adopted.
During the operation, under local anesthesia, my team successfully completed the transfemoral atrial septal defect closure. Venous atrial septal puncture was performed, and a 16 mm MemoCarna oxide film single-riveted ASD occluder was delivered through a 10F sheath, and the precise release of the occluder was completed at the expected position. The results were satisfactory, and the atrial shunt disappeared successfully. The entire operation took only about 30 minutes, and the purpose of safe and efficient treatment was truly realized.
It is worth mentioning What’s more, this is the first time that our hospital has applied the domestic MemoCarna oxide film single-riveting ASD occluder. From the perspective of structural design, this occluder has achieved great breakthroughs in metal content, disk structure and technology; The unique “mandala pattern” weaving process and no steel sleeve design of the disc make it significantly reduce the metal implantation volume and overall height compared with the traditional occluder, and the disc surface is smoother. The volume ratio is smaller, it is easier to endothelialize, and the risk of thrombosis is lower. During this operation, my team also felt the convenience of delivery and release of the occluder. The geometric pattern design of the head end makes The front end of the occluder is softer, and the possibility of tissue damage in the cardiac cavity is greatly reduced. In terms of operation feel and structural design, this domestic ASD occluder is not inferior to imported devices.< /p>
At present, the importance of congenital heart disease at home and abroad is constantly deepening; and after strengthening the awareness of prevention and treatment, we have found that there are indeed many patients with congenital heart disease that have not been discovered and treated clinically. In the first three months of this year alone, our hospital has treated about 20 patients with congenital heart disease, which shows that there is still a large demand for treatment in this field. As the leader unit of the structural group of Beijing Cardiovascular Society, our hospital plans to carry out more active work in congenital heart disease in the future. On the one hand, we will continue to strengthen the publicity and education of congenital heart disease, postoperative follow-up work, and regularly organize multidisciplinary academic exchange and discussion activities to strengthen the awareness and attention of colleagues in various departments, especially neurology and emergency departments, on unexplained stroke; At the same time, our hospital has also set up a structural heart disease team, which is specially responsible for the diagnosis and treatment and research tasks of congenital heart disease. On the other hand, we also plan to carry out some large-scale congenital heart disease screening and enrolment research work, and introduce as many new types of interventional occlusion devices as possible to bring the most advanced, safe and excellent treatment effects to patients.
In fact, for a long time in the past, the interventional occlusion treatment of congenital heart disease has not made great breakthroughs, but it is worth celebrating that the current There are more and more excellent new occluders like MemoCarna flooding into the market. Domestic occlusion devices have achieved remarkable results in the exploration of degradable materials and optimization of morphological structures, and it can even be said that they have completely reached the international leading level. As clinicians, we are very much looking forward to the emergence of a new type of occluder that is completely degradable and does not affect re-intervals in the future. At the same time, we also hope that with the advancement of technology, more minimally invasive, greener and more radiation-free congenital heart disease interventions can be achieved clinically. Treatment optimization brings the gospel to more patients!
This article is the original content of “Outpatient Clinic”
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