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 assess the efficacy and safety of percutaneous closure of patent ductus arteriosus (PDA) solely under echocardiography guidance. Methods We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups: a femoral artery approach group (n=143) and a femoral vein approach group (n=57). In the femoral artery approach group, there were 42 males and 101 females aged 3.20±5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30±11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram. Results All 200 patients were successfully treated with percutaneous closure of PDA. The patients’ gender, in-hospital stay, rates of occluder detachment were similar between the two groups (P>0.05). Compared with the femoral vein approach group, the femoral artery approach group had a younger age (3.20±5.63 yearsvs. 7.30±11.36 years, P<0.001), less body weight (14.25±11.54 kgvs. 24.25±19.14 kg, P<0.001) and shorter diameter of PDA (3.06±0.79 mmvs. 5.93±0.68 mm, P<0.001) and PDA occluders (5.43±1.00 mmvs. 12.14±0.54 mm, P<0.001), but had higher hospitalization expenses (32 108.2±3 100.2 yuanvs.25 120.7±3 534.1 yuan, P<0.001). In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up. Conclusion Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.
Objective To determine the efficacy and safety of Amplatzer transcatheter closure and surgical closure for ostium secundum atrial septal defects. Methods MEDLINE (1966-July 2006), EMBASE (1966-July 2006), The Cochrane Library (Issue 2, 2006) and CBMdisc (1979-July 2006) were searched for randomized controlled trials or non-randomized controlled trials. Data were extracted by two reviewers using a specially designed extraction form. The quality of included trials was critically assessed. The Cochrane Collaboration’s RevMan 4.2 software was used for data analysis. Results Sixteen non-RCTs involving 2 043 patients were included. No deaths were reported in 14 trials. The other two trials reported one death respectively in the surgical group. Meta-analysis of 12 trials involving 1 722 patients showed that the procedure success rate for the Amplatzer group was lower than that for the surgical group [WMD:0.95, 95%CI (0.92,0.98)]. Similar results were also found in the complete closure rate in 24-hour follow-up [6 trials involving 1 106 patients, WMD:0.96, 95%CI (0.92 to 1.00)], the complication rate [16 trials involving 1 971 patients, WMD:0.27, 95%CI(0.21 to 0.35)] and the transfusion rate [14 trials involving 1 807 patients, WMD:0.03, 95%CI(0.02 to 0.06)]. Conclusions The success rate for Amplatzer device closure of ASD is lower than that of surgical repair. However, the complication rate, length of hospital stay and transfusion rate are lower or shorter for Amplatzer device closure than for surgical repair. Based on appropriate patient selection, Amplatzer closure of ASD is a safe and effective alternative to surgical repair.
Objective To systematically evaluate the safety and efficacy of percutaneous closure of atrial septal defect (ASD) guided by echocardiography alone versus fluoroscopy. Methods The databases of PubMed, The Cochrane Library, EMbase, VIP, Wanfang Data and CNKI from January 2000 to October 2021 were searched by computer for relevant research literature. Two reviewers independently screened the literature, extracted the data and evaluated the quality according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Results A total of 19 cohort studies and 1 randomized controlled study were collected, including 2 825 patients. The Newcastle-Ottawa Scale score for cohort studies was≥7 points. Meta-analysis showed that there was no statistical difference in the operative success rate (RR=1.01, 95%CI 1.00 to 1.02, P=0.17), incidence of occluder displacement/shedding (RR=0.77, 95%CI 0.26 to 2.27, P=0.63), incidence of arrhythmia (RR=0.50, 95%CI 0.21 to 1.14, P=0.10), incidence of pericardial effusion (RR=0.98, 95%CI 0.32 to 2.98, P=0.97), operative time (MD=–0.23, 95%CI –7.56 to 7.10, P=0.95) or cost (SMD=–0.39, 95%CI –1.09 to 0.30, P=0.27) between the two groups. The echocardiography group reduced the incidence of total postoperative complications (RR=0.42, 95%CI 0.30 to 0.60, P<0.001) and residual shunt (RR=0.70, 95%CI 0.50 to 0.98, P=0.04), and shortened length of hospital stay (MD=–0.43, 95%CI –0.77 to 0.09, P=0.01). Conclusion Compared with traditional fluoroscopy-guided percutaneous closure of ASD, echocardiography guidance alone is equivalent in terms of operative success rate, major postoperative complications, operative time and total cost, but it reduces the incidence of total postoperative complications and residual shunt, and has a shorter length of hospital stay.
目的評價單穿刺點經胸微創封堵治療房間隔缺損（ASD）合并室間隔缺損（VSD）的安全性及有效性。 方法納入2014年6月至2015年8月于我院成功完成單穿刺點經胸微創封堵術治療ASD合并VSD的8例患兒，分析患兒在術后第l個月、3個月、6個月的門診隨訪資料。觀察圍術期及隨訪期間患者殘余分流、瓣膜反流、心律失常等并發癥發生情況。 結果8例患兒中，術后早期均無殘余分流、心律失常，微量三尖瓣反流（TR）患者1例（12.5%）。平均隨訪時間5～9（6±2）個月，各瓣膜均未發現中度及以上反流，未發現存在血栓、嚴重心律失常、死亡的患者。 結論單穿刺點經胸微創封堵治療ASD合并VSD安全、有效，且更為微創。
【摘要】 目的 評價經食管超聲心動圖(TEE) 監測房間隔缺損封堵術的臨床價值。 方法 手術前應用經胸超聲心動圖(TTE)及TEE篩選符合條件的100例單純房間隔缺損(ASD)患者行封堵術;手術中TEE監測整個封堵過程和引導封堵傘的放置;手術后評價封堵效果、殘余分流或并發癥等。 結果 100例患者均應用TTE和TEE確診,導引和監測成功閉合房間隔缺損。技術成功96例,成功率96%;4例失敗,失敗率4%。手術后復查無1例殘余分流,3例胸腔積液。經胸超聲心動圖與TEE診斷結果完全一致率40%,TEE診斷對手術前TTE診斷做出補充或修正診斷的有60例(60%)。結論 TEE對選擇適合行封堵術者、選擇封堵器大小、指導封堵器的釋放、以及療效評價均具有重要的作用。【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.
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.