Objective To explore the feasibility of transcatheter closure of congenital heart disease (CHD) under the guidance of transthoracic echocardiography (TTE). Methods A total of 37 patients with CHD who received transcatheter closure under the guidance of transthoracic echocardiography from November 2013 through November 2015 in our hospital were recruited. There were 15 males and 22 females, aged 1 to 16 years. Among them 32 patients suffered atrial septal defect and 5 patients had patent ductus arteriosus. The transcatheter closure of CHD was performed under the guidance of TTE. The patients underwent echocardiography follow-up at one, three and six months after surgery. Results Closure devices were successfully implanted in 37 patients under TTE guidance. The procedure was simple and safe. During the follow-up, no severe complication such as valvular injury, pericardial effusion, residual shunt and peripheral vascular injury occurred. Conclusion Transcatheter closure of CHD under TTE guidance is a feasible method and worth further clinical application.
ObjectiveTo study effect of different surgical treatments for patent ductus arteriosus in children.MethodA total of 38 patients with patent ductus arteriosus who underwent surgical treatment of cardiothoracic surgery between January 2016 and December 2017 in our hospital were as an observation group (12 patients with severing suture, 26 patients with ligation, 14 males and 24 females, aged 0.08–8.67 years). In the same period, 38 patients with patent ductus arteriosus who underwent interventional closure in the Department of Cardiology were as a control group (17 males and 21 females, aged 0.50–5.42 years). The clinical effectiveness of the two groups was compared.ResultsThe operation time, postoperative hospital stay, and blood transfusion rate in the observation group were higher than those in the control group with statistical differences (P<0.05). There was no statistical difference in intraoperative blood loss and complications between the two groups.ConclusionsIn patients with a single patent ductus arteriosus or a small catheter, interventional closure of the patent ductus arteriosus is less trauma and faster recovery. But in patients with lower weigh, premature, other intracardiac malformations, large catheter, moderate or severe pulmonary hypertension, the surgery is better.
Doubly committed sub-arterial ventricular septal defect (VSD) is a unique type of VSD which is located beneath both the aortic and pulmonary valve. Open-heart repair is traumatic especially for pediatric patient while trans-catheter device closure is also not suitable for this type of VSD. Minimally invasive per-ventricular device closure has been introduced as an alternative method in the treatment of doubly committed VSD with encouraging results. In the review, we will illustrate the surgical technique as well as perioperative management strategy as for this technique in treating doubly committed VSD.
ObjectiveTo evaluate the mid-term safety, efficacy and feasibility of perventricular device closure for subarterial ventricular septal defect.MethodsClinical data of 97 patients diagnosed with subarterial ventricular septal defect through echocardiography in West China Hospital from September 2013 to December 2015 were retrospectively analyzed. There were 66 males and 31 females aged 3 (1.8, 5.9) years. All the patients underwent perventricular device closure under the guidance of transesophageal echocardiography using eccentric occlusion device. Possible complications such as residual shunt, valvular regurgitation, atrioventricular conduction block and arrhythmias were recorded during the 1-year, 3-year and 5-year follow-up.ResultsAll the patients received perventricular device closure successfully except that 1 patient underwent open surgical repair under cardiopulmonary bypass 3 months later because of the migration of device. So the rate of complete closure was 99.0%. No residual shunt, moderate or severe valvular regurgitation, atrioventricular conduction block or arrhythmias were observed 5 years later.ConclusionTreating subarterial ventricular septal defect through perventricular device closure exhibits remarkable mid-term efficacy, safety and feasibility with high success rate.
Objective A meta-analysis was performed for a comparison of outcomes between transcatheter closure and transthoracic closure for simple congenital heart diseases (CHD). Methods Electronic databases, including PubMed, EMbase, Scopus, CNKI, Wanfang Data and Weipu Data were searched systematically for the literature aimed mainly at comparing the therapeutic effects for CHD administrated by transcatheter closure and transthoracic closure. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. The meta-analysis was conducted with Revman 5.3. Results Twelve studies meeting the inclusion criteria were included, involving 8 studies regarding to atrial septal defect (ASD), 2 studies regarding to ventricular septal defect (VSD) and 2 studies with regard to patent ductus arteriosus (PDA). A total of 1 423 patients were included. It was observed that compared with transthoracic closure, transcatheter closure entailed a lower complication rate (OR=5.62, 95%CI 2.78 to 11.36, P<0.001). However, meta-analysis of operative success rate(OR=1.65, 95%CI 0.92 to 2.98, P=0.09), instantly (OR=0.75, 95%CI 0.40 to 1.41, P=0.37) and long-term (OR=0.72, 95%CI 0.25 to 2.05, P=0.54) persistent shunt after surgery showed no significant differences between two approaches. No publication bias was found according to the funnel plot of complication rate and operative success rate. Conclusion In the treatment of simple CHD such as ASD, VSD and PDA, compared with transthoracic closure, a lower complication rate were associated with transcatheter closure. Meanwhile, operative success rate, instantly and long-term persistent shunt after surgery were not statistically different between the two surgical approaches. However, this study was based on retrospective studies, the level of evidence remained low. More large sample size randomized controlled trials should be designed to explore the safety and effectiveness of these two approaches in the treatment of CHD.
Objective To compare the effects of transthoracic device closure and surgical closure on ventricular septal defect systemically. Methods A systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Chinese Clinical Trial Register, ClinicalTrials. gov and Wanfang Database up to July 31, 2016. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted using RevMan 5.0 and Stata 14.0 software. Results Eleven studies were identified, including 5 RCTs and 6 cohort studies involving 2 504 patients. For success rate, there was no statistical difference between the transthoracic closure group and the surgical closure group in RCT (RR=0.99, 95%CI 0.96 to 1.03, P=0.70); the success rate in the transthoracic closure group was lower than that in the surgical closure group in the cohort study (OR=0.21, 95%CI 0.08 to 0.55, P=0.002). Both results of RCTs and cohort studies showed that compared with surgical closure, transthoracic device closure reduced duration of the operation (RCT MD=–79.38, 95%CI –95.00 to –63.76, P<0.000 01; cohort studyMD=–66.26, 95%CI –71.20 to –61.31, P<0.000 01) and hospital stay (RCTMD=–2.10, 95%CI –2.65 to –1.55, P<0.000 01; cohort studyMD=–3.99, 95%CI –6.03 to –1.94, P=0.000 1), and the patients with blood transfusion (RCT RR= 0.04, 95%CI 0.01 to 0.11, P<0.000 01; cohort studyOR=0.01, 95%CI 0.00 to 0.13, P=0.001). In the transthoracic closure group the risk of postoperative arrhythmia reduced (RCT RR=0.20, 95%CI 0.13 to 0.32, P<0.000 01; cohort studyOR=0.46, 95%CI 0.31 to 0.67, P<0.000 1). In the transthoracic closure group a higher postoperative valvular regurgitation risk in RCT induced (RR=1.45, 95%CI 1.07 to 1.96, P=0.02) and the rate of postoperative valvular regurgitation in cohort study reduced (OR=0.43, 95%CI 0.20 to 0.92, P=0.03). However, there was no statistical difference in postoperative residual shunt (RCT RR=0.96, 95%CI 0.57 to 1.62, P=0.89; cohort study OR=0.52, 95%CI 0.12 to 2.25, P=0.38). Conclusion Transthoracic device closure can shorten duration of the operation, hospital stay and reduce the patients with blood transfusion and post- and intraoperative arrhythmia risk. Therefore, transthoracic device closure may be a better approach for some ventricular septal defect patients.
目的评价单穿刺点经胸微创封堵治疗房间隔缺损（ASD）合并室间隔缺损（VSD）的安全性及有效性。 方法纳入2014年6月至2015年8月于我院成功完成单穿刺点经胸微创封堵术治疗ASD合并VSD的8例患儿，分析患儿在术后第l个月、3个月、6个月的门诊随访资料。观察围术期及随访期间患者残余分流、瓣膜反流、心律失常等并发症发生情况。 结果8例患儿中，术后早期均无残余分流、心律失常，微量三尖瓣反流（TR）患者1例（12.5%）。平均随访时间5～9（6±2）个月，各瓣膜均未发现中度及以上反流，未发现存在血栓、严重心律失常、死亡的患者。 结论单穿刺点经胸微创封堵治疗ASD合并VSD安全、有效，且更为微创。
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 assess the safety and efficacy of a new surgical strategy, perventricular device closure, for the treatment of subarterial ventricular septal defect (VSD). MethodsThirty-nine patients younger than 10 years with subarterial VSD who received surgical repair in West China Hospital from November 2010 to May 2012 were included in this study. There were 18 male and 21 female patients with their age of 5.9±3.2 years. Perventricular device closure was performed with eccentric device under the guidance of transesophageal echocardiography (TEE). Residual shunt, valvular regurgitation (including aortic regurgitation)and arrhythmias during perioperative period and follow-up were analyzed. ResultsThirty-three patients successfully received perventricular device closure, and 6 patients received conversion to open surgical repair. Postoperative ICU stay was 2.2±0.8 days, and length of hospital stay was 4.8±1.8 days. Major postoperative complications included residual shunt and mild or less aortic regurgitation. Mean follow-up duration was 7±2 months. No obvious arrhythmia, moderate or severe valvular regurgitation was observed during follow-up. ConclusionPerventricular device closure is safe, efficacious and minimally invasive for the treatment of subarterial VSD in pediatric patients with suitable anatomic characteristics with good mid-term results.