| BackgroundAtrial Septal Defect(ASD)refers to an abnormal connection between left and right atrium caused by agenesis of atrial septum.The intervention of atrial septal defect guided by echocardiography has become the latest method of occlusion,with the advantages of avoiding X-ray irradiation and thoracotomy,which can be guided by Transesophageal Echocardiography(TEE)in a real-time dynamic mode from multiple angles throughout the process,and can observe the intracardiac structure closely,without being restricted by the conditions of chest acoustic window.It can clearly display the type of atrial septal defects and residual situation,and clarify the swollen tumor or porous gap of atrial septum,which have obvious advantages in the exposure of the visual field between the gap and the posterior lower margin.The objective of this paper is to explore the clinical value of TEE-guided percutaneous intervention in the treatment of infants.ObjectiveA comparative study of TEE guided(ASD)transcutaneous and X-ray transcatheter closure and transthoracic small incision and the analysis of postoperative efficacy.MethodsThe data of patients with ASD who had been treated by TEE-guided percutaneous interventional therapy in our hospital from January 2019 to December 2019 were analyzed retrospectively.According to different surgical methods,the patients were divided into three groups including research group(TEE-guided percutaneous interventional occlusion),control group 1(X-ray percutaneous interventional occlusion),control group 2(surgical transthoracic small incision),with 20 patients in each group randomly.The patients in allthree groups were aged between 1-3 years old.The preoperative transthoracic echocardiography screening showed that all the patients had atrial septal secondary perforation defect without other heart malformation or organ dysfunction.And finally,we compared postoperative hospital stay,postoperative cardiac function evaluation,success rate of occlusion,incidence of postoperative residual shunt and related complications of the patients in the three groups.Results1.Research Group: 19 cases were successful and 1 case was unsuccessful.The reason for the failure was TEE was found that the residual margin was soft which was difficult to support the sealing umbrella,so it was replaced by surgical repair.Among the 19 successful cases,there was 1 case with a residual shunt of 1mm and 1 case was suggested to be pericardial effusion,both were disappeared completely after discharge.Control Group 1: 19 cases were successful and 1 case was unsuccessful.The unsuccessful one case was because the large type of occlusion umbrella affected the movement of valve.Among the successful 19 cases,there was 1 case with residual leakage,which was successful after replacing the occlusion umbrella,and there was another 1 case being suggested that there was the residual shunt of 2 mm from the edge,which disappeared 3 months later.Control Group 2: All the 20 cases were successful.Among them,there was 1 case being suggested pericardial effusion after operation,which disappeared after 3 months re-examination,and there was another case with pleural effusion together,which was gradually absorbed during hospitalization.2.There was no obvious difference in the success rate of surgery of research group compared with the two control groups,but the hospitalization time,postoperative residual shunt incidence and postoperative complications of research group and control group 1were significantly lower than control group 2.No obvious trauma was found in research group during operation,no X-ray was taken in,and cardiac function of patients recovered fastest after the operation.And there was no perforation of heart,death of infection,movement and fall off of blocking umbrella occurred in the three groups.3.The cardiac function of research group was reviewed by transthoracic ultrasound,and the left ventricular ejection fraction LVEF value was detected by M-mode echocardiography,which were higher than before operation,with no complications occurred.In control group 1,the position of the blocking umbrella was good after operation,blood routine examination was done 1 month and 3 months after the operation respectively to observe laboratory indexes.In control group 2,the postoperative reexamination showed that there was inflammatory scar hyperplasia on the surface wound of some children.After follow-up,the research group had the shortest hospitalization days among the three groups of different surgical patients,which had the most significant recovery of left ventricular systolic function compared with the pre-operation.There were no death cases and no complications such as occluder embolism and displacement in 1-3months after follow-up in the three groups.ConclusionTEE-guided percutaneous interventional occlusion of atrial septal defect is a new type of minimally invasive surgical method completed with the guidance of esophageal ultrasound real-time dynamic monitoring technology.Iits treatment effect was obvious,avoiding X-ray intake and body surface trauma,with low incidence of complications and fast postoperative recovery and clear intraoperative image vision combined with TEE’s advantages of anti-interference.Therefore,it is a simple,safe and feasible new minimally invasive surgical method,which is worthy of further clinical application. |
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