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.
ObjectiveTo explore the key points, indications and safety of trans-jugular transcatheter closure of atrial septal defect (ASD) in infants.MethodsThe clinical data of 53 infants with ASD from January 2017 to May 2019 in our hospital were retrospectively reviewed. There were 20 males and 33 females with the age of 1.2 (0.5-2.9) years, and body weight of 9.0 (6.8-10.6) kg. The ASD diameter was 9.8 (8.0-14.0) mm. Thirty-one patients were treated under the guidance of transesophageal ultrasound (TEE), and the other 22 patients under the guidance of transthoracic echocardiography (TTE). We used the steerable curved sheath through the internal jugular vein under the guidance of echocardiography, and the average occluder size was 13.5±4.5 mm.ResultsAll of the 53 patients were successfully occluded, and none of them changed to radiation-guided or transthoracic surgery. Postoperative hospital stay was 3.35±0.70 d. There was no complication such as peripheral vascular injury, occluder malposition or displacement, serious arrhythmia or pericardial effusion. The patients were followed up for 14.3±5.1 months without arrhythmia, residual shunt, occluder malposition or displacement or thrombus.ConclusionEchocardiography-guided trans-jugular closure of ASD for infants with low weight and large ASD shunt or patients with inferior vena cava abnormalities not suitable for femoral vein treatment, not only overcomes the radiation risk of radiation guidance, but also maintains the advantages of minimal invasiveness and safety, providing a new treatment option for such patients.
ObjectiveTo compare the efficacy of additional tricuspid valve annuloplasty (TVP) and isolated closure for atrial septal defect (ASD) with moderate to severe tricuspid regurgitation (TR). MethodsClinical data of the patients diagnosed with ASD combined with secondary moderate to severe TR and treated in our hospital from January 2009 to June 2020 were retrospectively analyzed. Patients were divided into a TVP group and a non-TVP group based on whether TVP was performed simultaneously. The baseline data of two groups were matched with a ratio of 1∶1 propensity score. ResultsA total of 32 pairs from 257 patients were successfully matched. In the TVP group, there were 24 females and 8 males with an average age of 44.0±13.1 years. In the non-TVP group, there were 28 females and 4 males with an average age of 44.5±11.6 years. The TR area and estimated pulmonary artery pressure in the two groups were significantly decreased compared with preoperation (all P<0.001). The TR area (P=0.001) and the estimated pulmonary artery pressure (P=0.002) were decreased more significantly in the TVP group than those in the non-TVP group. Linear regression analysis showed that age and preoperative TR area had a positive correlation with TR area at follow-up (β=0.045 and 0.259, respectively, both P<0.05), while additional TVP had a negative correlation (β=–1.542, P=0.001). ConclusionAdditional TVP can significantly reduce the TR area and pulmonary artery pressure, and elderly patients with severe TR before surgery should actively receive TVP.
ObjectiveTo systematically review the efficacy and safety of totally thorascopic (TT) and median sternotomy (MS) approaches for atrial septal defect repair (ASDR). MethodsDatabases including The Cochrane Library (Issue 2, 2016), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to June 2016, to collect randomized controlled trials or cohort studies about TT vs. MS approaches for ASDR. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 11 cohort studies involving 687 patients were included with 305 patients in the TT group, and 382 patients in the MS group. The results of meta-analysis showed that: The TT group had shorter postoperative ventilation time (MD=-1.49, 95%CI -2.27 to -0.71, P=0.000 2), postoperative ICU stay time (MD=-7.30, 95%CI -12.07 to -2.53, P=0.003), hospital stay time (MD=-2.06, 95%CI -2.80 to -1.32, P<0.000 01) and less postoperative drainage (MD=-199.83, 95%CI -325.96 to -73.70, P=0.002) than the MS group. But the bypass time (MD=9.42, 95%CI 1.55 to 17.30, P=0.02) and aortic clamping time (MD 6.78, 95%CI 3.48 to 10.07, P<0.000 1) of the TT group were significantly longer than those of the MS group. ConclusionCompared with MS, TT can significantly reduce the length of postoperative ventilation, postoperative ICU stay, hospital stay and postoperative drainage. But there are risks of prolonged bypass time and aortic clamping time in the TT group. Due to the quantity and quality of the included studies, the above conclusions still needs to be verified by carrying out more studies.
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.
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 summarize the experience of surgical treatment of complete atrioventricular canal defect （CAVCD） in 94 patients. Methods Ninety-four patients with CAVCD underwent surgical therapy. CAVCD were repaired by using two-patch technique in 65 patients and using single-patch technique in 29 patients. Additional cardiovascular anomalies were corrected simultaneously. Results There were 10 hospital deaths （10.6%）, 4 patients were less than 6 month old. Four patients died of severe mitral valve regurgitation, 3 died of pulmonary hypertensive crises and 3 died of low cardiac output syndrome, cerebral complications and aerothorax separately. Follow-up was completed in 84 patients, with a duration of 3-6 months. Mild degree mitral valve regurgitation was observed in 18 patients by echocardiography, mild to middle degree mitral valve regurgitation was observed in 12 patients. Conclusions Postoperative severe mitral regurgitation and pulmonary hypertensive crises were the main cause of deaths for correction of CAVCD. Early correction of CAVCD and satisfactory reconstruction of atrioventricular valve could obtain a satisfactory result, routine evaluation with intraoperative transesophageal echocardiography could result in a low operative mortality.
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.
ObjectiveTo compare clinical outcomes between biatrial ablation and right atrial ablation in the surgical treatment of atrial fibrillation (AF)for adult patients with atrial septal defect (ASD). MethodsClinical data of 47 patients with ASD and AF who underwent surgical ASD repair and radiofrequency ablation from January 2007 to December 2012 were retrospectively analyzed. There were 20 male and 27 female patients with their age of 35-76 years. AF duration ranged from 3 months to 15 years. There were 18 patients with persistent AF and 29 patients with long-standing persistent AF. There were 10 patients with mild-to-moderate or more severe mitral regurgitation (MR), and 28 patients with mild-to-moderate or more severe tricuspid regurgitation (TR). According to different surgical strategies, all the 47 patients were divided into 2 groups. In right atrial ablation group, there were 19 patients who received ASD repair and right atrial ablation. In biatrial ablation group, there were 28 patients who received ASD repair and biatrial ablation. For patients with mild-to-moderate or more severe MR or TR, concomitant mitral or tricuspid valvuloplasty was performed. All the patients received 24-hour Holter monitoring at 3, 6 and 12 months after discharge, and were intermittently followed up thereafter. ResultsCardio-pulmonary bypass time, aortic cross-clamping time and postoperative hospital stay of biatrial ablation group were significantly longer than those of right atrial ablation group. But there was no statistical difference in postoperative morbidity or recovery between the 2 groups. After heart rebeating, there were 25 patients (89.3%)with sinus rhythm (SR)and 3 patients with junc-tional rhythm (JR), and none of the patients had AF in biatrial ablation group. There were 14 patients (73.7%)with SR, 2 patients with JR and 3 patients with AF in right atrial ablation group. At discharge, 28 patients (100%)in biatrial ablation group had SR, and in right atrial ablation group there were 15 patients (78.9%)with SR and 4 patients with AF relapse (P=0.045). All the patients were followed up for 3-75 months, and there was no death or residual ASD shunt during follow-up. Two patients had mild-to-moderate or more severe MR, and 4 patients had mild-to-moderate or more severe TR. Cumulative SR maintenance rate of biatrial ablation group (87.7%±6.7%)was significantly higher than that of right atrial ablation group (47.4%±11.5%, P=0.003)at 2 years after discharge. ConclusionFor adult patients with ASD and AF, biatrial ablation can produce better clinical outcomes than right atrial ablation without increasing surgical risks.
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.