Background: ASD secundum in adults is often associated with coronary heart disease. Meanwhile there is no commonly adopted tactics for the treatment of such patients: should it be simultaneous or staged?
Purpose: to evaluate clinical effectiveness and reasonability of simultaneous correction of ASD and coronary stenting in adults.
Material and methods: 55 patients underwent endovascular ASD closure, in 5 of them (8,6%) this procedure was combined with simultaneous coronary stenting. The average age of these patients was 63,2 ±7,0 years. The average number of implanted stents per patient was 2,0 ±1,0.The average size of ASD assessed by TEE was 12,8 ±2,9 mm.
Results: at first we performed coronary stenting followed by ASD closure with Figula Flex occluder. Technical success rate was 100%. Five ASD occluders were implanted in 5 patients. The average diameter of occluders was 21,8±8,1 mm. Coronary stenting was performed in all cases, in 2 patients – after successful recanalization of chronic occlusion. Early postoperative period was uneventful. At control examination (the average follow-up period 13,5±1,5 months) complete defect closure persisted in all patients. The right heart volumes significantly decreased. At TEE, the RA volume decreased from 48,6±5,6 to 32,6±3,8 cm³ (р<0,01), the RV volume – from 43±6,1 to 32,4±4,8 cm³ (р<0,01), mean PAP decreased from 45,4±11,3 to 25,6±6,8 mm Hg (р<0,01). Preoperative symptoms disappeared in all 5 patients. Control CAG confirmed persisting effect of PCI. According to exercise testing, physical tolerance increased from 68,5 ±11,8 to 85,3 ±12,4 Wt.
Conclusion: simultaneous combined endovascular ASD closure and coronary stenting in adults is quite safe and effective and provides greater comfort for the patients by reducing their hospital stay. The performance of these procedures did not lead neither to significant increase of contrast medium expenditure, nor to the increase of patients’ X-ray exposure.
