Objective To access the feasibility, effectiveness and safety of transcatheter closure of ventricular septal defects(VSD) in 17patients. Methods Seventeen patients, aged 4 23 years, were selected by transthoracic echocardiography. The location of VSD was perimembranous in 16 patients and was muscular in 1 patient. And 1 patient with aneurysm formation. All cases had no severe pulmonary hypertension or right to left shunt. Membranous VSD underwent transcatheter closure with Amplatzer membranous VSD occluder or membranous VSD occluder made in China. Muscular VSD was closed by Amplatzer patent ductus arteriosus occluder. Results The VSD diameter ranged from 2.3 10.5 mm(5.75±2.10 mm). The device diameter ranged from 412 mm (7.12±1.67 mm). After application of the prosthesis there was no residual shunt in all patients. One patient developed grade I atrioventricular block and complete right bundle branch block. Two patients developed right bundle branch block after 3 4 days. No other compli...更多cations were observed in 1 12 months follow up. Conclusion The transcatheter closure of VSD appears to be a safe and effective method.
Objective To introduce the application of transcatheter closure of multi-fenestrated atrial septal defect (ASD) via femoral vein under ultrasound guidance with amplatzer cribriform occluder (ACO) and atrial septal defect occluder (ASDO), as well as to assess its feasibility, effectiveness and safety. Methods The clinical data of 48 patients with fenestrated ASD occluded via femoral vein under ultrasound guidance from December 2015 to May 2018 in our hospital were retrospectively analyzed, including 17 males and 31 females, aged 10 months to 51 years, an average of 11.50±13.86 years, and weighting 6-79 (27.00±20.14) kg. Among 48 patients with fenestrated ASD, 12 patients had double-foramen and 13 atrial septal aneurysm combined with defects and 23 multi-foramen. All patients underwent transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) to complete the closure of fenestrated ASD. Ultrasound, electrocardiogram and chest X-ray were reviewed the next day after surgery to evaluate the curative effect. Results Forty-eight patients with ASD were treated with 49 occluders, due to one patient with two occluders. There were 29 ASDO (8-26 mm) and 20 ACO (18-34 mm). During the operation, TTE/TEE examination showed that 48 patients were completely occluded, 13 patients showed fine bundle shunt in the unreleased push notification rod, and 9 patients had fine bundle shunt after the release of push notification rod. Fine bundle shunt was found in 8 patients 24 hours after operation, and microshunt was found in 3 patients 1 year after operation. All the patients were followed up. The occluder position was good. The right heart was reduced in different degrees, and the X-ray showed that the pulmonary blood was reduced in different degrees. No arrhythmia was found by electrocardiogram after operation. Conclusion It is a safe and effective method to use ACO and ASDO to occlude ASD through femoral approach under ultrasound guidance.
目的 观察和评价采用偏心型封堵器导管介入治疗干下型室间隔缺损的近期疗效和安全性。 方法 2011年8月－12月，6例经无主动脉瓣脱垂的干下型室间隔缺损（直径≤7 mm）患者（年龄＞3岁）在杂交手术室接受介入治疗。造影评估后，建立动静脉轨道，在保留导丝的情况下置入合适型号的国产偏心型室间隔缺损封堵器，并于术后定期随访复查。 结果 6例患者缺损直径4～7 mm（平均5.3 mm），其中5例成功地接受了导管介入封堵治疗，置入封堵器直径5～9 mm（平均6.4 mm）。仅1例因封堵器置入后出现主动脉瓣受压影响关闭，即改由外科微创经胸封堵成功。所有患者在随访期内，无栓塞、残余分流、瓣膜功能障碍、房室传导阻滞、死亡等并发症。 结论 无主动脉瓣脱垂的干下型室间隔缺损患者接受导管介入封堵治疗是安全、可行的，且短期随访结果良好。
Atrial septal defect (ASD) is a congenital heart disease that causes blood communication between the left and right ventricles due to partial atrial septal tissue defects, accounting for about 13% of all heart malformations. Secondary ASD is the most common type of ASD and can generally be treated with minimally invasive closure. At present, the commonly used minimally invasive methods in clinical practice mainly include X-ray-guided percutaneous occlusion, transesophageal ultrasound-guided transthoracic occlusion and ultrasound-guided percutaneous occlusion. This review focuses on the basic research process of occluder materials, and advantages and disadvantages of three different surgical methods.
Objective To explore the safety and efficacy for patients with central airway-pleural fistula (APF) treated by atrial septal defect (ASD) occluder. Methods This was a retrospective study. Between January 2017 and October 2021, a total of 16 patients with postoperative APF were treated with ASD occluder through bronchoscope under local anesthesia combined with sedation. The efficacy and complication were recorded during and after the procedure. Results Sixteen patients were recruited in this study and the average age was 60.7 years (range 31 - 74 years). The main etiology for APF was lobectomy/segmentectomy (n=12), pneumonectomy (n=2), radical esophagectomy (n=1) or decortication for chronic empyema (n=1). Totally, 4 fistulas were located in right main bronchus, 3 in left main bronchus, 3 in right upper bronchus, 1 in right middle bronchus, 2 in right lower bronchus and 3 in left upper bronchus. The median diameter of APF was 7.8 mm (ranged from 4 to 18 mm) and the median diameter of ASD occluder inserted was 10.0 mm (ranged from 6 to 20 mm). Successful occlusion of APF was observed in 15 patients (15/16) and 1 patient died of multiple organ failure caused by bacteremia 14 days after the procedure. Fourteen patients were recruited for long-term follow-up, on a median follow-up period of 16.2 months (ranged from 3 to 46 months). There were 12 patients of complete remission and 2 patients of partial remission and only one patient took a second operation due to the enlargement of fistula and translocation of occluder. At follow-up, 4 patients died and the reasons were directly related to the primary etiology, and no patient died due to APF recurrence. Conclusion Endobronchial closure of central APF using ASD occluder is a minimally invasive but effective modality of treatment with satisfactory long-term outcome.
ObjectiveTo introduce implantation methods of different types of congenital heart disease occluder for the treatment of bronchopleural fistula (BPF) and its preliminary efficacy.MethodsThree patients who diagnosed with BPF and treated by congenital heart disease occluder were reviewed. The clinical data was analyzed after comprehensively reviewing of relevant literature.ResultsAll the three patients were treated with postoperative BPF and empyema. The diameter of the fistula ranged from 3 to 8 mm. We used occlusive devices for congenital heart diseases such as atrial septum (ASD), ventricular septum (VSD) defect or patent ductus arteriosus (PDA), respectively. After treatment, all three patients were cured of BPF and empyema caused by BPF in a short time, and the thoracic drainage tube was successfully removed. During the follow-up period from 7 to 25 months, no significant long-term complications were observed.ConclusionThe use of ASD, VSD and PDA occluder for the treatment of BPF with a fistula more than 3 mm is effective and safe.
Currently, transcatheter intervention is the preferred treatment for patients with anatomically suitable atrial septal defects. However, the use of nickel-titanium alloy occluders in interventional procedures results in lifelong presence of the implant in the body, leading to complications such as metal allergies and arrhythmias in some patients. To overcome the short-term and long-term complications associated with the presence of metal, and to avoid radiation exposure and metal toxicity, this paper reports a case of successful transcatheter closure of atrial septal defect in a pediatric patient with metal allergies using fully biodegradable occlude under ultrasound guidance, achieving excellent results by interventional therapy.
Objective To analyze the influencing factors and outcomes of atrial septal defect (ASD) and ventricular septal defect (VSD) occlusion guided by echocardiography. Methods We retrospectively analyzed the clinical data of 188 patients receiving transthoracic and percutaneous transcatheter closure of ASD and VSD from July 2009 to July 2017 in our department, including 74 males and 114 females, aged 13.48±13.53 years ranging from 1 to 65 years. Results Fifty-three ASD patients accepted transthoracic closure surgery, of whom 4 patients were difficult to close and 6 patients failed to close; 24 patients underwent percutaneous transcatheter ASD occlusion surgery, of whom 3 were difficult to close and 1 failed in occlusion; 108 VSD patients implemented transthoracic closure surgery, of whom 10 patients were difficult to close and 5 patients failed in closure; 9 VSD patients underwent percutaneous transcatheter closure, of whom 5 failed and then was converted to transthoracic closure. Our study showed that too large or too small aperture was the independent risk factor. Two kinds of closure surgery had their own advantages and disadvantages. The special type of VSD was the influencing factor of transthoracic closure. Conclusion When the ASD diameter≥25 mm, transthoracic closure is the best choice to avoid the use of large occluder. When the ASD diameter<25 mm, percutaneous closure surgery is the best choice. When the ASD diameter≥35 mm, it is best to give up the closure operation. Technical improvements can significantly raise the closure success rate of the subarterial VSD. For the entry diameter>10 mm and membranous aneurysm with multi-break, occlusion surgery should be avoided in VSD.