Comparative Study Between Transcatheter Closure Using Amplatzer Septal Occluder And Surgical Repair In Patients With Secundum Atrial Septal Defect

Objective: To explore the organic influence of transcatheter closure(TC) using Amplatzer septal occluder and surgical repair(SR) by accessing and comparing the changes of cytokine myocardial injury and blood corpuscle components perioperatively between TC and SR in patients with secundum atrial septal defect. Methods: From May to December 2004, 12 patients with transcatheter closure and 12 patients with surgical repair were enlisted according to the diagnosis of ASD. The interventional approach was administrated with Amplatzer septal occluder. There were no significant differences in the two groups in age, sex ratio, left ventricular ejection fraction, or ASD diameter.The changes of plasma TNF-α and IL-10 troponin I and blood routine count in two groups were analyzed respectively and compared by collecting a serial peripheral venous blood samples perioperatively. Results:1. The changes of cytokine(TNF-α and IL-10): The parameters above were similar before operations in two groups.After operation, serum levels of cytokine TNF- α and IL-10 in SR group increased significantly at 2h (P<0.01 ), and they were on the decline at 6h and restored the nearly similar levels of preoperation at 24h(P>0.05), while serum levels of cytokine TNF- α and IL-10 in TC group were similar to the preoperative ones and decreased clearly at 2h and 6h (P<0.01) comparatively between SR group and TC group.2. The changes of Troponin I (cTnI): The parameters above were similar before operations in two groups.After operation, serum levels of cTnI in SR group increased significantly (P<0.01) and were higher than normal at 3d, while serum levels of cTnI in TC group increased slightly (P<0.05) and restored the normal levels at 1d, which were much lower than the ones in SR group postoperatively.3. The changes of blood corpuscle count(WBC RBC and PLT count ) : The parameters above were similar before operations in two groups. After operation, WBC count in SR group was higher than normal (P<0.01) and still increased at 1d and 2d and was similar to normal ones at 4d; RBC and PLT count in SR group decreased clearly (P<0.05) and were on the rise and was similar to normal ones at 1d and 2d respectively. The parameters in TC group postoperatively were similar to the preoperative ones.Conclusion: The transcatheter closure using Amplatzer septal occluder for ASD is a very effective approach for the appropriate-indication patients under transthoracic echocardiograph(TTE) guidance preoperatively.Compared with surgical repair and it has dominant position in inflammatory response myocardial injury and blood injury postoperatively.The results show that it results in mild jury and rapid recovery which are the advantages of microinvasive operation.