"Application Of Tranesophageal Echocardiography In Minimally Invasive Surgical Closure Of Ventricle Septal Defect."

Background:Ventricle septal defect is one of the most common congenital heart diseases around the world. In this study we analyzed the clinical outcomes value of transesophageal echocardiography (TEE) in probe-assisted minimally invasive surgical closure of Ventricular Septal Defect (VSD) showing the efficacy of the applied technique.Methods:In this study we included50patients from Shandong provincial hospital to participate from June2010to March2012. The patients were divided in different groups according to gender, age, weight, and type of defect they had. Transesophageal echocardiography was used before surgery to choose an appropriate Amplatzer occluder device according to the location, type and size of the ventricular septal defect. Transesophageal echocardiography was performed during the surgery to choose the position of the purse and to guide the occluder device. As per minimally invasive surgery a short mini incision was given, after the transesophageal echocardiography determined the size and its position, a catheter was introduced into the right ventricle of the heart. With careful observation and looking at the color jet flow on echocardiography the catheter was introduced into the left ventricle through the right ventricle. The first disc was deployed in the left ventricle and pulled towards the right ventricle following by the deployment of the second disc in the right ventricle till echocardiography did not show any residual shunt. Thus in this study we used transesophageal echocardiography in minimal invasive surgical closure of the ventricle septal defect and to analyze the clinical effect immediately after the surgery. Transthoracic Echocardiography was used to detect the complications after closure of the ventricle septal defect. Results:In these50patients, the solid probe method was used to assist the surgery in25patients, and the hollow probes were used in20patients. The rest of the5patients underwent the method of direct delivery system. All the patients went through transthoracic and transesophageal echocardiography pre and postoperatively. The transesophageal echocardiography findings were more remarkable as compared to the transthoracic echocardiography. TEE showed better results. After the deployment of the occluder device the ventricle defect was seen through multiple planes to evaluate if there was any residual shunt or jet flow. Closure of the ventricular septal defect was successfully performed in all the patients. There were1mm residual shunts in two patients after the operation. All patients were discharged in3-4days after the operation. During the follow-up period of1to12months, no complications on transthoracic echocardiography were seen such as Amplatzer defluvium, Amplatzer displacement, hemolysis or atrioventricular heart-block.Conclusions! With the refinement of the probe assisted minimally invasive surgical closure of ventricular septal defect, intra operative transesophageal echocardiography provides accurate assessment of patch integrity and reveals the presence of additional muscular defects after termination of cardiopulmonary bypass, the valuable and accurate information for further confirmation of diagnosis of VSD. So TEE plays an important role in probe-assisted minimally invasive surgical closure of VSD, and makes it a simpler, feasible and high-success surgical method.