ObjectiveTo summarize clinical outcomes of atrial septal defect (ASD)occlusion for patients with ASD and tricuspid regurgitation (TR). MethodsBetween July 2006 and January 2012, 98 patients with ASD and TR under-went ASD occlusion in Xinhua Hospital, Shanghai Jiaotong University School of Medicine. There were 36 male and 62 female patients with their age aging from 2 months to 80 years. All ASD were secundum ASD with their diameter of 3-23 mm. There were 60 patients with mild TR, 28 patients with moderate TR, and 10 patients with severe TR. All the patients received ASD closure without specific management for TR, including 51 patients under digital subtraction angiography (DSA), 46 patients via a minithoracotomy approach, and 1 patient guided by transthoracic echocardiography. All the patients were followed up with echocardiography to evaluate changes of TR after ASD closure. ResultsThere was no in-hospital death. ASD occlusion was not successful in 1 patient who was found to have residual ASD shunt on the third postoperative day. Another patient underwent reexploration for abnormal bleeding on the third postoperative day. All the other patients had uneventful postoperative recovery. Eighty-four patients were followed up for 1-64 (26.56±21.35)months. During follow-up, the patient who have residual ASD shunt on the third postoperative day received open chest repair 6 months after discharge. TR of 73 patients (86.90%)improved in different degrees. Preoperative severe TR in 10 patients changed into mild TR in 8 patients, moderate TR in 1 patients and still severe TR in 1 patient. Preoperative moderate TR in 26 patients changed into none TR in 6 patients, mild TR in 18 patients and still moderate TR in 2 patients. Preoperative mild TR in 48 patients changed into none TR in 40 patients and still mild TR in 8 patients. ConclusionFor patients with ASD and TR, conservative treatment strategy is recommended. Simple ASD closure can provide satisfactory clinical outcomes, and also avoid adverse complications of cardiopulmonary bypass including myocardial injury and lung injury.
ObjectiveTo compare the effects of transthoracic device closure and traditional surgical repair on atrial septal defect systemically.MethodsA systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Wanfang Database up to July 31, 2018 to identify trials according to the inclusion and exclusion criteria. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted by RevMan 5.3 and Stata 12.0 software.ResultsThirty studies were identified, including 3 randomized controlled trials (RCTs) and 27 cohort studies involving 3 321 patients. For success rate, the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.34, 95%CI 0.16 to 0.69, P=0.003). There was no statistical difference in mortality between the two groups (CCT, OR=0.43, 95%CI 0.12 to 1.52, P=0.19). Postoperative complication occurred less frequently in the transthoracic closure group than that in the surgical repair group (RCT, OR=0.30, 95%CI 0.12 to 0.77, P=0.01; CCT, OR=0.27, 95%CI 0.17 to 0.42, P<0.000 01). The risk of postoperative arrhythmia in the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.56, 95%CI 0.34 to 0.90, P=0.02). There was no statistical difference in the incidence of postoperative residual shunt in postoperative one month (CCT, OR=4.52, 95%CI 0.45 to 45.82, P=0.20) and in postoperative one year (CCT, OR=1.03, 95%CI 0.29 to 3.68, P=0.97) between the two groups. Although the duration of operation (RCT MD=–55.90, 95%CI –58.69 to –53.11, P<0.000 01; CCT MD=–71.68, 95%CI –79.70 to –63.66, P<0.000 01), hospital stay (CCT, MD=–3.31, 95%CI –4.16, –2.46, P<0.000 01) and ICU stay(CCT, MD=–10.15, 95%CI –14.38 to –5.91, P<0.000 01), mechanical ventilation (CCT, MD=–228.68, 95%CI –247.60 to –209.77, P<0.000 01) in the transthoracic closure group were lower than those in the traditional surgical repair group, the transthoracic closure costed more than traditional surgical repair during being in the hospital (CCT, MD=1 221.42, 95%CI 1 124.70 to 1 318.14, P<0.000 01).ConclusionCompared with traditional surgical repair, the transthoracic closure reduces the hospital stay, shortens the length of ICU stay and the duration of ventilator assisted ventilation, while has less postoperative complications. It is safe and reliable for patients with ASD within the scope of indication.
ObjectiveTo evaluate the efficacy and safety of a novel wire for echo-guiding percutaneous atrial septal defect (ASD) closure.MethodsTwenty sheep were randomly divided into two groups, an experimental group and a control group (n=10 in each group). In both groups, an animal model of ASD was established by transthoracic balloon dilatation, and percutaneous closure of atrial septal defect was finished only by echography guiding. The total procedure time, passing time (time needed for the guide wire to enter the left atrium), frequency of delivery sheath dropping into right atrium, frequency of arrhythmias and rate of complications were compared between the two groups.ResultsASD model was uneventfully established in all animals. ASD devices were successfully implanted in all sheep. Compared with the control group, the experimental group had significantly less mean procedure time and mean passing time, lower frequency of guide wire dropping into right atrium and frequency of atrial and ventricular premature contractions, respectively (15.36±4.86 min vs. 25.82±7.85 min, 2.69±0.82 min vs. 5.58±3.34 min, 0% vs. 40.0%, 4.41±2.61 vs. 9.60±3.68, 0.75±0.36 vs. 1.34±0.68; all P<0.05) . Two groups did not have serious complications within postoperative one week.ConclusionThe novel wire system is not only safe and effective in the treatment of ASD occlusion, but also easy to operate.
Objective To analyze the safety and effectiveness of ultrasound-guided thoracoscopic atrial septal defect (ASD) closure. Methods We prospectively collected the clinical data of 12 patients with ASD treated by ultrasound-guided thoracoscopic ASD closure in Fuwai Hospital from January to September 2017. The characteristics of the patients' ASD and operation, operation safety and effectiveness, postoperative complications and follow-up results were analyzed. Results Among the 12 patients, 10 were successfully treated with ultrasound-guided thoracoscopic ASD closure. Two patients switched to ASD repair under thoracoscopy-assisted cardiopulmonary bypass. The size of the ASD was 17-40 (27.22±8.97) mm and the size of the occluder was 36 (30-42) mm. The average postoperative length of hospital stay was 6 days. There were no complications such as arrhythmia, bleeding and pericardial effusion after operation. The average follow-up was 6 (3-10) months after the operation. During the follow-up, no Ⅲ-degree conduction block, occluder dislocation, residual shunt or cardiac pericardial effusion was found. Conclusion Ultrasound-guided thoracoscopic ASD closure is a minimally invasive, safe and effective treatment. This technique provides a new minimally invasive surgical option for patients with large defect diameter and poor edge condition.
Objective To therapy the atrial septal defect(ASD) much more better, comparative study of clinical outcomes in surgical treatment of ASD to other three minimally invasive procedures was performed. Methods From June 2007 to March2008, 652 ASD patients had undergone surgery（n=301）, transcatheter closure (n=274), openchest Hybrid closure(n=50) and without tracheal intubation Hybrid closure (n=27) of ASD. Patients were and divided into four groups according to the different procedures. Retrospectively we compared the data of patient’s age, hospital stay, trauma, cost of hospitalization, blood transfusion, anesthesia, tracheal intubation and postoperative fellowup. Results Median age and weight of openchest Hybrid and without tracheal intubation Hybrid groups were significantly less than those of the other two groups (Plt;0.01). The achievement ratio of four groups were 100.0％,97.2％,92.6％,100.0％. There was statistically difference in the achievement ratio of four groups (Plt;0.01). [CM(158.5mm]Median hospital stay and cost of blood transfusion of transcatheter closure and without tracheal intubation Hybrid groups were significantly less than other two groups (Plt;0.01). The mean cost of hospitalization in four groups were 24 802.90±360.96￥，25 095.07±437.13￥，24 856.77±445.87￥，24 853.56±673.99￥ respectively. There was no statistically difference in the cost of hospitalization(Pgt;0.05). All patients were recovered and discharged without eventuality. The mean followup time were 4.64±0.32 month，4.57±0.31 month，4.49±0.28 month，4.62±0.31 month. There was no statistically difference in the followup time (Pgt;0.05). The complication rate of postoperative incision were 3.32％，0.47％，6.00％，0.00％. The transcatheter closure and without tracheal intubation Hybrid groups were significantly less than other two groups (Plt;0.01). Conclusions The mean cost of hospitalization in four procedure were almost the same. The ability to close any ASD regardless of its size, location or patient’s age remains an important advantage of surgery. Transcatheter closure of ASD has the advantage of less complications. But there are limitationsto lowerweight and infant patients. OpenChest Hybrid closure offers a valuable and complementary operative approach for any age patients. Without extracorporeal circulation, it reduces trauma significantly but it always has few surgery injury. Without tracheal intubation Hybrid closure without tracheal intubation can be used for patients of any age. The cost of hospitalization is not higher than surgical treatment and transcatheter closure. The success of procedure is high and the incidence of postoperative complications is lower. It is an ideal treatment to infant ASD patients especially to lowerweight and younger infant patients.
【摘要】 目的 评价经食管超声心动图(TEE) 监测房间隔缺损封堵术的临床价值。 方法 手术前应用经胸超声心动图(TTE)及TEE筛选符合条件的100例单纯房间隔缺损(ASD)患者行封堵术;手术中TEE监测整个封堵过程和引导封堵伞的放置;手术后评价封堵效果、残余分流或并发症等。 结果 100例患者均应用TTE和TEE确诊,导引和监测成功闭合房间隔缺损。技术成功96例,成功率96%;4例失败,失败率4%。手术后复查无1例残余分流,3例胸腔积液。经胸超声心动图与TEE诊断结果完全一致率40%,TEE诊断对手术前TTE诊断做出补充或修正诊断的有60例(60%)。结论 TEE对选择适合行封堵术者、选择封堵器大小、指导封堵器的释放、以及疗效评价均具有重要的作用。【Abstract】 Objective To evaluation the clinical role of transesophageal echocardiography (TEE) for atrial septal defect (ASD) blockade operation. Method The 100 patients with ASD were selected on transthoracic echocardiography (TTE) and TEE. During operation, TEE was applied to monitor the procedure of occlusion, to guide the occluder cites, to evaluate the effects and to make sure if there were peripheral residual shunts around the occlusion and other complications. Results All of the patients were exactly diagnosed by TTE and TEE，guiding and evaluating the successful closed ASD. The successful rate of occlusion was 96%，the failure rate was 4%. The review after surgery showed that, there were no residual review, pleural effusion in three patients. The concordance rate of TTE and TEE diagnosis result is 40%. TEE diagnosis amend the preoperative TTE diagnosis in 60 patients (60%). Conclusions TEE plays an important role in select inpatients，determining the size of the occluder，correctly before occlusion operation, guiding the placement of the occluder in operation and evaluating the effect after operation.
Objective To investigate the surgical treatment of adult secondary atrial septal defect with paroxysmal atrial fibrillation. Methods We retrospectively analyzed the clinical data of 84 patients with adult secondary atrial septal underwent surgical treatment in Beijing Anzhen Hospital from January 2002 through May 2013. There were 31 males and 53 females at mean age of 56.3 (24-72) years. Eleven patients were treated by cardiopulmonary bypass operation with 6 patients by radiofrequency catheter ablation simultaneously. Seventy three patients were implanted with septal defect closure with 52 patients by radiofrequency ablation simultaneously. Rhythm of the heart was detected at the immediate postoperative period, 7 days, 3 months and 6 months after the operation. Results No preoperative death, thoraecotomy and no arrhythmic complications in all the patients no matter with or without RF occurred. In the patients with cardiopulmonary bypass operation, the time of aortic occlusion was 35.21±12.32 min, the cardiopulmonary bypass time was 45.67±16.93 min, and the ICU observation time was 11.87±12.36 hours. In the patients with septal defect closure implanted, ICU observation time was 10.93+13.67 hours. The incidences of atrial fibrillation in the patients with radiofrequency ablation on postoperative 7 days，3 months and 6 months were lower than those in the patients without radiofrequency ablation (P<0.05). Conclusion For adult secondary atrial septal defect patients with paroxysmal atrial fibrillation, no matter cardiopulmonary bypass operation or septal defect closure implanted, radiofrequency ablation at the same time is safety and can reduce incidence of recurrence of atrial fibrillation.
Objective To summarize the experiences of surgical treatment for partial atrioventricular canal defect. Methods The data of 66 patients of surgical treatment for partial atrioventricular canal defect from January 1984 to December 2007 were analyzed retrospectively. The cleft of mitral valve presented in all of those patients. There were 52 cases with direct suture on cleft, 8 cases with direct suture with commissurroplasty, 1 case with posterior leaflet plasty, 3 cases with direct suture St.Jude ring and 2 cases mitral valve replacement. The ostium primum atrial septal defects were repaired with patches of Dacron in 12 cases and autologous pericardium in 54 cases. Coronary sinus was situated on the left atrium in 5 and ostium primum atrial septal defects were repaired in Kirklin’s way; the others in MeGoon’way. Meanwhile other heart abnormalities were done. Results There were two early deaths (3.03%), one patient died of heart arrhythmia and one patient died of respiratory failure. Complications of total A-V block was in 2 cases. Both of them were replanted with pace makers.52 cases were followed up, followup time was 5 months to 22 years(mean follow-up 15 years). All patients had better life. Four patients have been re -operated for different reasons post primary operation. One had good result after re-mitral valve replacement. One case died of acute renal failure and the other two died of low cardiac output syndrome. Conclusions Early operation is definitely recommended when the diagnosis is confirmed. Because the structure or function of mitral valve is saved, pulmonary hypertension is avoided and the mortality is lower in the future. The key points of operation are to rectify the mitral insufficiency, repair ostium primum atrial septal defects and avoid atrioventricular block. The patients of mild regurgitation of mitral valve have good results. Provided in those have more than middle regurgitation of mitral valve then their longterm results are poor.
Objective To evaluate long-term outcomes of surgical closure of atrial septal defect (ASD) and combined surgical radiofrequency ablation for atrial fibrillation (AF). Methods A total of consecutive 15 patients with ASD undergoing surgical closure of ASD and combined surgical radiofrequency ablation in our department between March 2003 and April 2015. There were 7 males and 8 females at an average age of 47.1±10.8 years ranging from 16 to 62 years. Retrospective analysis and follow-up were performed to evaluate long-term success rate freedom from AF after surgery. Results All patients recovered and discharged, and no patient suffered death or stroke. The duration of follow-up was from 3 to 136 months for all patients. Success rate freedom from AF at 1, 3, 5 and 10 years was 81.3%, 75.0%, 68.8% and 61.1%, respectively. During follow-up, there was no death or stroke. One patient required permanent pacemaker implantation. Conclusion Concomitant surgical closure of ASD and biatrial radiofrequency ablation is safe and effetive with better long-term outcomes. It is necessary to perform the two procedures together for ASD patients.
Objective To compare surgical results between real-time three dimensional echocardiography（RT-3DE） guided closure of atrial septal defect （ASD） through a right minithoracotomy and traditional surgical repair under cardiopulmonary bypass （CPB）. Methods Sixty-four patients with secundum ASD received surgical repair in the First People’s Hospital of Honghe Autonomous Prefecture from April 2009 to April 2012. According to different surgical approach, all the patients were divided into group A and B. In group A, 35 patients underwent traditional ASD repair under CPB including 20males and 15 females with their age of 12-56 （16.4±4.0） years. In group B, 29 patients received real-time RT-3DE guidedASD closure through a right minithoracotomy without CPB, including 20 males and 15 females with their age of 15-50 （18.5±0.2） years. Operation time，postoperative mechanical ventilation time，hospital stay，chest drainage，mortality，morbidity and follow-up outcomes were compared between the 2 groups. Results Operation time （110.47±35.90 minutesvs. 159.32±20.60 minutes），postoperative mechanical ventilation time （10.40±22.30 hours vs. 16.40±12.20 hours），chestdrainage （106.71±85.20 ml vs. 146.70±75.63 ml）and postoperative hospital stay （4.0±1.0 days vs. 7.0±1.0 days）ofgroup B were significantly shorter or less than those of group A. In group A, 1 patient died postoperatively and 7 patientshad postoperative complications. In group B, there was no in-hospital mortality and 3 patients had postoperative complications.Postoperative morbidity of group A was significantly higher than that of group B （20.0% vs. 10.3%，P＜0.05） . ConclusionFor ASD patients with definite surgical indications，RT-3DE guided ASD closure through a right minithoracotomy has more advantages over traditional surgical repair under CBP.