| Objective:To analyze the clinical indexes of patients with atrial septal defect(ASD)who were treated by transcatheter echocardiography(TEE)guided transcatheter closure and right chest small incision repair,and to compare the postoperative curative effect,intraoperative situation and complications,so as to explore the safety and feasibility of transcatheter closure of ASD under the guidance of TEE.Methods:From August 2017 to April 2020,33 patients with ASD treated by TEE guided interventional occlusion.From ASD patients who underwent right chest small incision repair in our hospital,33 patients with similar age and defect size as TEE group were selected as control group(small incision group).The intraoperative conditions(operation time,incision length,cardiopulmonary bypass time),postoperative conditions(success rate,ventilator assistance time,hospitalization time,hospitalization cost)and complications(residual shunt,pneumothorax,pleural effusion)were compared between the two groups.Echocardiography was performed 1 month and 3 months after operation to observe the changes of left ventricular diameter(LVD),left atrial diameter(LAD),right ventricular diameter(RVD)and left ventricular ejection fraction(LVEF)were compared before and after operation.Results:66 cases of ASD were completed in the two treatment groups.All the patients were cured and discharged.The noise in the precordial area disappeared.No residual shunt was found in the follow-up examination.No occluder displacement and new valve regurgitation were found in the postoperative examination in the TEE group.General situation of patients in TEE group and small incision group before operation:the gender(male/female)(9/24 vs 12/21,P=0.43),age[(12.73±4.16)vs(13.33±3.45),P=0.52],weight[(36.76±11.68)Kg VS(35.18±9.31)Kg,P=0.56],height[(145.88±16.70)cm VS(150.78±14.81)cm,P=0.21],defect size[(15.15±3.99)mm vs(16.33±4.23)mm,P=0.25]there was no significant difference(P>0.05).Intraoperative condition:operation time[(36.61±6.55)min VS(194.27±26.66)min,P<0.05],cut length[(1.41±0.20)cm VS(6.27±0.67)cm,P<0.05],cardiopulmonary bypass time[0 min VS(64.09±8.42)min,P<0.05]was statistically significant(P<0.05).Postoperative situation:operation success rate(97%VS 100%,P＝0.24),incidence of complications(12%VS 15%,P=0.72),hospitalization expenses[(37532.38±4818.30)yuan VS(38623.37±3921.42)yuan,P=0.32]was no significant difference(P>0.05),ventilator assist time[(6.61 ± 1.06)h VS(12.88±1.08)h,P<0.05],length of stay[(6.45±1.01)d VS(9.73±1.01)d,P<0.05]was statistically significant(P<0.05).Reexamination of echocardiography after transcatheter closure of ASD guided by TEE,LVEF[(60.52±4.31)%VS(62.00±4.32)%,P<0.05]、LVD[(40.94±6.76)mm VS(44.57±5.44)mm,P<0.05]、LAD[(29.21±6.69)mm VS(33.18±7.03)mm,P<0.05]、RVD[(26.21±7.68)mm VS(18.36±4.26)mm,P<0.05]was statistically significant(P<0.05).Echocardiography was reexamined in the right chest small incision repair group,LVEF[(61.39±2.11)%VS(62.58±1.70)%,P<0.05]、LVD[(42.48±4.47)mm VS(46.51±3.23)mm,P<0.05]、LAD[(26.67±4.65)mm VS(33.39±4.24)mm,P<0.05]、RVD[(24.58±5.25)mm VS(17.70±1.90)mm,P<0.05]was statistically significant(P<0.05).There was no significant difference in cardiac geometry between the two groups(P>0.05).Conclusion:Transesophageal echocardiography can monitor the release process of occluder from multiple cardiac sections to ensure the safety of operation.For atrial septal defect with indications,TEE guided ASD interventional closure has a high success rate,no serious complications occurred in the short-term follow-up,hemodynamics returned to normal,cardiac structure gradually improved,and the safety and effectiveness of small incision repair of right chest were similar.Compared with small incision repair of right chest,TEE guided ASD interventional closure has the advantages of less trauma,shorter hospitalization period and no need of cardiopulmonary bypass,but it needs to strictly grasp the surgical indications.For ASD with indications,TEE guided interventional closure should be given priority. |
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