| Introduction:Echocardiography,including transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), is one of the most common tools used for evaluating cardiac function and structure. It features non-invasive and simple operation, accurate and repeatable results, with no significant radioactive damage both to patients and doctors. It reveals inner cardiovascular structures and hemodynamic changes in real time and in clarity. Transcatheter closure has been widely used for treating congenital heart disease. However, due to its operating path and requirement for contrast medium, there are still some limitations. In recent years, occlusion via small chest incision under the guidance of TEE is gradually developing. With the improvement of occluders and the expanding range of indications, this technology is becoming increasingly favored by surgeons and patients. Unfortunately, it is possible that the placement of the occluder might affect the function and structure of neighboring tissues and cause severe complications. Therefore, surgeons should pay attention to these three major issues:1) suitable indications;2) the size and model of the occluder;3) strict intraoperative monitoring and efficacy assessment. Our study focused on the exploratory development of a clinical criterion in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation.for the safety and successful rate of occlusion via small chest incision.with application of color doppler imaging. The research can be described in five chapters in general.Objective:To elucidate the clinical application value of echocardiography technology (including transthoracic echocardiography and transesophageal echocardiography) in occlusion of children’s ASD via small chest incision, particularly focusing on the application of this technology in screening cases, choosing occluders, guiding and monitoring the placement of the occluder, and postoperative follow-ups as well.Methods:We performed occlusion of ASD via small chest incision on111children. The patients were diagnosed by transthoracic echocardiography(TTE). Multiple sections were examined to quantify the ASD size and to evaluate the remaining margins. In general, the size of occluders to be selected is the maximum diameter of the defects+4mm. During operations we reassure the size of the occluders, meanwhile, guide the placement of the occluders by multiplane transesophageal echocardiography (MTEE). Patients also received postoperative follow-ups at regular intervals. MTEE were employed to assess the therapeutic efficacy.Results:Out of the111ASD cases, defects of107patients were successfully closed, making a96.4%successful rate. Images for positive closures displayed firmly insertion of the occluders in defect regions, along with disappearance of blood flow thorough atrial spectrum while neighboring valves and blood flow inside atrium appeared to be normal. In3of the4failed cases, we failed to get the occluder in right position due to extremely short defect margins or no margin at all. The operation on the last case who was diagnosed with multiple secundum ASD was abandoned as a result of apparent remaining regurgitation after the placement of the occluder. Some patients received follow-ups at intervals of1week,1month,3months,6months and1year post-operation. The occluders stayed fixed, no severe atrioventricular valve regurgitation was observed.3cases showed occasional regurgitation which later disappeared6months post operation.Conclusion:Echocardiography(including TTE and MTEE) gives accurate and accountable result. During occlusion of ASD via small chest incision, echocardiography technology can play vital roles in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation. Objective:To elucidate conventional and special lab indexes detected by echocardiography (including TTE and MTEE) during occlusion of VSD via small chest incision. In addition, to discuss the potential of using these indexes in helping screen cases, choosing occluders, guiding and monitoring the placement of the occluders, and postoperative follow-ups as well.Methods We performed occlusion of VSD via small chest incision on223children. Before operations multiple sections TTE was employed to evaluate various status including the size, position and type of the VSD region along with the condition of neighboring tissues. In general, the size of occluders to be selected is the maximum diameter of the defects+2mm. During operations we reassured the size of the occluder, meanwhile, guided the placement of the occluder by multiplane transesophageal echocardiography (MTEE). Patients also received postoperative follow-ups at regular intervals. MTEE were employed to assess the therapeutic efficacy.Results:Out of the223VSD cases, defects of206patients were successfully closed,making a92.38%successful rate. Successful rate varied among different types of VSD, with the lowest chance of success in subarterial VSD. Some patients received follow-ups at intervals of1week,1month,3months,6months and1year post-operation. The occluders stayed firmly and echoed clearly. No notable residual shunt or valve regurgitation was discovered. Conclusions:Echocardiography(including TTE and MTEE)gives accurate and accountable result. During occlusion of children’s VSD via small chest incision, echocardiography technology can play vital roles in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation. Objective:To compare the echocardiography and clinical results from children received occlusion of ASD/VSD via small chest incision to that received traditional surgery, and investigate the advantage and disadvantage of occlusion via small chest incision.Methods:Children with ASD or VSD admitted to The Second Xiangya Hospital, Central South University between April2010to July,2010were divided into2groups (occlusion group and traditional surgery group,40cases each group) basing on corresponding treatments. We then compared various key performance indicators including successful rate, incision length, parameters of echocardiography, complications, quantity of blood transfusion, duration of ICU stay and hospitalization, along with hospitalization expense as well.Results:Both groups yielded100%successful rate. Echocardiography found both treatments led to similar therapeutic efficiency. Compared to traditional surgery group, occlusion group showed decreased quantity of blood transfusion, shorter duration of ICU stay and entire hospitalization but higher expense.Conclusion:With the precise evaluation and reliable guidance of echocardiography, occlusion via small chest incision can achieve similar therapeutic efficiency as traditional surgery, along with smaller wounds and faster recover. However, it also costs higher expenses. Objective:To discuss indications for asymmetric occluder; and elucidate the critical role of echocardiography in choosing occluder, guiding successful occlusion and avoiding injury during operation. Methods:Retrospective study55cases received occlusion via small chest incision using asymmetric occluder to analyze VSD type, size and morphology suitable for asymmetric occluder. Therapeutic efficiency was evaluated by follow-ups.Results:Out of the55successful cases treated with asymmetric VSD occluder,70.90%of which were perimembranous VSD (disruption of tumor in membranous part of interventricular septum18%, subcristal VSD12.72%, others56.41%), funnel area VSD accounted for the other29.09%(intracristal VSD27.27%, subarterial1.81%)。In general, the size of occluders to be selected was the maximum diameter of the defects+2～3mm. Follow-ups showed that occluders were placed and fixed properly. No severe residual shunt, valve regurgitation or heart block was discovered.Comclusions:Application of asymmetric occluder expands the range of indications for occlusion via small chest incision. Also, accurate echocardiography helps improving the safety and successful rate of this surgery. Objective:To analyze the possible reasons held accountable for the failed occlusion via small chest incision; to gain better knowledge of the indications for this technology and more clinical experiences.Methods:We examined24failed cases carefully in the factors such as the size, position and type of defects, as long as neighboring tissues and operation technique. Special anatomic malformations discovered during traditional surgery after failed occlusion were also inspected.Results:Out of the24failed cases,5were ASD patients, the other15were diagnosed as VSD (3of them were subarterial VSD,15were perimembranous VSD, the other one was muscular VSD).Our study showed that, as for the ASD cases, besides the defect area being too large, lack of margins and multiple secundum defects also may cause the failure. The VSD cases were more complicated. Size of the defects (too large or too small), distance between the defect region and neighboring valves (too close), multiple defects, orientation and angle of the defects, abnormal chordae tendineae as well as inadequate operation techniques all might be responsible for the failure.Conclusion:The combination of experienced echocardiography and excellent surgical technique is the decisive factor for a successful occlusion via small chest incision. |
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