| Background and Object:At present,many domestic centers have carried out transthoracic ultrasound(TTE)and transesophageal ultrasound(TEE)guided percutaneous atrial septal defect occlusion,compared with the results of the application of two methods of percutaneous closure of atrial deficiencies,and discussed more minimally invasive and economical method.Methods:Reviewing the perioperative data and follow-up data of 130patients with pure ultrasound guided percutaneous secondary atrial septal defect occlusion from March 2017 to March 2020 at the First Affiliated Hospital of Guangxi Medical University Patients with lack of closure were classified as TTE group(37 cases,19 cases of local anesthesia,18 cases of general anesthesia intubation,4 cases with hypertension,1 case with type 2 diabetes,11 males and26 females,age 29.13±19.75 Years old,BMI 20.23±4.09Kg/m~2,atrial defect maximum diameter 21.66±5.52mm,occluder model 24.00(20.00,30.00)mm),patients with complete TEE-guided atrial defect were classified as TEE group(93 cases,all were anesthetized trachea)Intubation,9 patients with hypertension,30 males and 63 females,aged 23.21±17.36 years old,BMI 18.98±4.09Kg/m~2,maximum atrial defect diameter 23.44±7.02mm,occluder size 30.00(22.00,34.00)mm),compare the application results of the two groups in sealing the atrial defect.The criteria for the patients included:1.The patient’s age≥2years old,weight≥10 kg;2.Atrial defect>8 mm;3.Cardiac ultrasonography suggested simple left-to-right shunt,enlarged right atrium and right ventricle.Exclusion criteria include:1.The maximum diameter of the atrial defect is greater than 36mm;2.The sinus-type atrial defect,primary orifice-type atrial defect,coronary sinus-type atrial defect,sieve-shaped hole-type atrial defect,atrial septal bulging tumor combined with an atrial defect;3.Atrial deficiency combined with other cardiac malformations that require surgical correction;4.Severe pulmonary hypertension,cardiac catheter check lung resistance is greater than 7wood;5.Combining hemorrhagic disease is not suitable for postoperative antiplatelet therapy.Immediately after placement of the occluder,perform TTE/TEE to check that the occluder is not displaced,pericardial effusion above medium volume,a large amount of residual shunt,new occurrence or aggravation of mitral regurgitation caused by the occluder,vena cava obstruction,pulmonary vein Obstruction and ECG monitoring showed no II°or III°atrioventricular block,then the blockade was considered successful.Re-examine TTE and electrocardiogram on discharge;instruct to review TTE and electrocardiogram at 1 month,3 months,6 months,12 months and every year after surgery,and carry out relevant physical examination and ask whether there are discomfort symptoms such as palpitations,headache,chest pain,etc..Cardiac color Doppler ultrasound examination for residual shunt,occluder displacement,embolization,newly added mitral regurgitation,moderate or above pericardial effusion,cardiac perforation,inferior vena cava or pulmonary vein obstruction.Electrocardiogram examination for new onset of atrioventricular block of degree II and above,new onset of atrial fibrillation or atrial flutter,and other non-sinus rhythms.Conclusion:1.Simple TTE and simple TEE guided percutaneous atrial septal defect closure are safe and feasible;2.Compared with simple TEE-guided percutaneous closure of atrial deficiencies,simple TTE-guided can simplify surgery and is a more economical and minimally invasive method. |
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