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。
Pulmonary arterial hypertension (PAH) is a severe, progressive disease leading to right ventricular failure and finally death. Lung transplantation is recommended for PAH patients who do not respond to targeted drug combination therapy or World Health Organization functional class (WHO FC) Ⅲ or Ⅳ. However, only 3% of PAH patients can recieve the lung transplantation. A novel implantable interatrial shunt device (ISD) can create a relatively fixed right-to-left shunt established by balloon atrial septostomy (BAS). The device may decompress the right sided chambers, facilitate left heart filling, improve organ perfusion and reduce the likelihood of syncope, acute pulmonary hypertensive crisis and death. The systemic oxygen transport improves despite hypoxemia. Implantation is simple, feasible and safe, and the X-ray time and operation time are short. There is no severe complication or thrombosis during the mid-term follow-up of the clinical studies and the device remained patent. The syncope symptoms, six-minute walk distance, cardiac index and systemic oxygen transport improve significantly in the patients. ISD may be currently the last alternative treatment to improve symptoms and prolong survival in currently drug-resistant patients with severe PAH.
Objective To evaluate the efficacy and safety of transthoracic minimally invasive occlusion operation for the treatment of congenital atrial and ventricular septal defects. Methods The clinical data of 88 patients who underwent surgical occlusion operation from December 2015 to February 2017 were summarized. There were 52 males and 36 females, aged 6.8±7.5 years ranging from 1.6 to 24.0 years. All the patients were followed up by ultrasound and electrocardiogram at postoperative 3, 6 and 12 months. The efficacy of minimally invasive thoracotomy was analyzed by statistical methods. Results The patients were followed up for 3-15 (6.8±2.3) months, and the follow-up rate was 92.0%. Ultrasound showed occluder fixed well and no residual shunt, valve regurgitation, thrombosis or other complications occurred. The heart was reduced, the ejection fraction was greater than 55%, and heart function rating for all patients was grade Ⅰ. Conclusion Transthoracic mini-invasive surgical occlusion of atrial and ventricular septal defects is safe and effective. The short and middle-term effect is satisfying. It can be widely used in clinical, but multi-center and long-term follow-up and assessment still need to be carried out.
ObjectiveTo summarize the experience of totally thoracoscopic cardiac surgery (TTCS) for atrial septal defect.MethodsClinical data of 442 patients undergoing TTCS for atrial septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 149 male and 293 female patients, aged 3-74 (29.1±14.3) years. Surgical procedures were performed through 3 ports at the right chest wall.ResultsAll the operations were completed successfully. Mean operative time was 1.5-4.6 (2.2±0.3) h. The mean extracorporeal circulation and aortic cross-clamp time was 28-118 (55.9±13.3) min and 8-78 (21.5±10.2) min, respectively. Mechanical ventilation and intensive care unit stay time was 3.5-122.0 (8.1±7.4) h and 13-141 (20.7±10.2) h, respectively. Postoperation drainage volume was 70-1 280 (251.8±131.5) mL. The hospital stay was 4-16 (7.1±1.4) d. Intraoperative and postoperative complications occurred in 15 patients (3.3%). The mean follow-up time was 1-128 (67.6±33.3) months, and during the period, there were 25 patients of atrial fibrillation, 25 patients of mild-moderate tricuspid valve incompetence, 1 patient of moderate tricuspid valve incompetence. There was no reoperation or residual shunt during the period of follow-up. And the heart function was improved.ConclusionTTCS is a feasible, safe and minimal invasive approach for patients with atrial septal defect and has good short to medium-term outcomes.
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 technique of performing minimally invasive Cox Maze Ⅳ procedure by bipolar clamp through right lateral minithoracotomy for atrial septal defect (ASD) combined with atrial fibrillation (AF) in adults. Methods Thirty-five patients (21 males, 14 females with age ranging from 45 to 73 years) with ASD and persistent or long-standing persistent AF received minimally invasive Cox Maze Ⅳ procedure and ASD closure from August 2012 to April 2016 at Department of Cardiothoracic Surgery, Xinhua Hospital. Diameter of left atrium ranged from 39 to 60 mm and left ventricle ejection fraction (LVEF) ranged from 48% to 62%. Diameter of ASD ranged from 20 to 35 mm. Cox-maze Ⅳ procedure was performed through right minithoracotomy entirely by bipolar radiofrequency clamp. Then, mitral or tricuspid valvuloplasty and surgical ASD closure was performed through right minithoracotomy. Results All patients successfully underwent this minimally invasive surgery. No patient needed conversion to sternotomy. The mean cardiopulmonary bypass time was 120.1±14.1 min. The mean aortic cross-clamp time was 79.5±12.2 min. There was no early death or pacemaker implantation perioperatively. The average length of hospital stay was 10.1±2.7 d. At a mean follow-up of 22.8±12.2 months, sinus rhythm was restored in 32 patients (32/35, 91.4%). Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was 89.1%±6.0%. Conclusion The minimally invasive Cox Maze Ⅳprocedure performed by bipolar clamp through right minithoracotomy is safe, feasible, and effective for adult patients with ASD combined with AF.
Objective To summarize the experiences of surgical treatment of sinus venosus atrial septal defect （SVASD）. Methods There were 32 patients of SVASD, all of them were associated with totally or partially right anomalous pulmonary venous connection. There were 25 cases of superior SVASD, 22 cases underwent double-patch procedure, 3 cases underwent Warden procedure. In 7 cases of inferier SVASD, 3 cases of Scimitar syndrome underwent ASD repair by pericardial patch and at the same time the anomalous pulmonary vein was divided and reimplanted to the posterior wall of left atrium, 4 cases of them underwent single-patch ASD repair. Results The surgical results were satisfying and no patient died, 28 patients were in sinus rhythm and echocardiography showed neither obstruction of caval vein and right pulmonary vein nor residual interatrial shunt. Conclusion SVASD mostly associated with right anomalous pulmonary venous connection according to its special anatomic structure. Preserving the function of sinus node and avoiding of obstruction of caval vein should be routinely considered when superior SVASD was repaired. The heart function of Scimitar syndrome should be followed-up for a long time for it usually associated with right lung hypoplasia.