| Purpose:To explore the relationship between the regurgitation degree of atrioventricular valve and the complication of atrial septal defects closure via chest.and identify how the closure of ASD affect the degree of atrioventricular valve regurgitation,and to oberve safety and effectivity and methods of the atrial septal defects closure via chest.method:we retrospective analyze the clinical findings of43patients who underwent closure of atrial septal defects via chest in our department between2002JAN and2011March.,40patients were guided by transoesophageal Chocardiography,while2patients were observed by transthoracic echocardiography, and all the patient’s cardioparameters were followed up by transthoracic echocardiography. For example,the change of the diameter of left atrium and ventricluar,and right atrium and ventricluar,the flow of pulmonary artery, the flow of aorta, the flow of matral valve,the regurgitation of mitral valve and tricuspid valve.make sure the regurgitation and morblity of mitral valve and tricuspid valve before operation and1month or6months after operation.for example the rate of severe complications and leakage after ASD closure. out of the43patients,41people sucessed,while,l person was given right transthoracic minilly invasive closure of atrial septal defect under cardiopulmonary bypass,1person died because of cardiac arrest in operation room,l person appeared acute renal failure2days afer operation.12persons were observed link from left atrial to right atrial just after operation,but disappeared one month later.the achievement ratio of operation is95.3%. transthoracic echocardiography demonstrated that one people had midrange mitral valve regurgitation, three people had severe tricuspid valve regurgitation, two people had midrange mitral valve regurgitation and severe tricuspid valve regurgitation,19people had mild valve regurgitation or midrange tricuspid valve regurgitation,18people had no atrioventricular valve regurgitation. three people had little hydrothorax viewed by stemite,12people had leakage after ASD closure and disappeared1month later,1people had one heart arrest,1people had acute kidney failure. The diameter of left ventricular was35.9±5.7mm,and38.8±6.6mm one month later,and was obviously larger than the diameter before operation when compared by SPSS13.0,P<0.01, and41.1±6.3mm six months later,and also obviously,P<0.01. The diameter of left atrium was27.6±8.7mm, and28.7±7.0mm one month later.the diameters of two months was similarly when compared by SPSS13.0,P>0.05, and30.0±7.6mm six months later,and was obviously larger than the diameter before operation when compared by SPSS13.0. The diameter of right ventricular was25.6±9.3mm, then25.6±9.3mm one month later,and24.0±8.4mm six months later, the diameter after operation was smaller when compared by SPSS13.0. The diameter of right atrium was46.3±13.9mm,40.8±11.0mm one month later,and40.4±12.9mm six months later, the diameter after operation was smaller.P<0.01. The interventricular septum before operation was8.4±1.8mm thick,and was8.7±1.7mm one month later,then8.70±1.69mm six months later, compared with preoperative no significant difference, P value greater than0.05。 interventricular septal thickness (IVS) was8.70±1.69mm, compared with preoperative, no significant difference, P value greater than0.05; there are25patients with no mitral valve regurgitation before surgery,while12patients with mild mitral valve regurgitation,4patients with moderate mitral valve regurgitation,no patient with severe mitral valve regurgitation. postoperative ultrasonography reveals that after one month7patients with no mitral valve regurgitation, while28patients with mild mitral valve regurgitation,4patients with moderate mitral valve regurgitation,one patient with severe mitral valve regurgitation.6months later, ultrasonography reveals that after one month6patients with no mitral valve regurgitation, while29patients with mild mitral valve regurgitation,4patients with moderate mitral valve regurgitation,2patients with severe mitral valve regurgitation.According to Statistical analysis,Preoperative, postoperative ultrasound results are differences,P less than0.001.there are11patients with no tricuspid valve regurgitation before surgery,while24patients with mild tricuspid valve regurgitation,4patients with moderate tricuspid valve regurgitation,2patients with severe tricuspid valve regurgitation. postoperative ultrasonography reveals that after one month11patients with no tricuspid valve regurgitation, while25patients with mild tricuspid valve regurgitation,4patients with moderate tricuspid valve regurgitation,one patient with severe tricuspid valve regurgitation.6months later, ultrasonography reveals that after one month10patients with no tricuspid valve regurgitation, while27patients with mild tricuspid valve regurgitation,3patients with moderate tricuspid valve regurgitation,1patients with severe tricuspid valve regurgitation.According to Statistical analysis,Preoperative, postoperative ultrasound results are simliar,P larger than0.05.preoperative mitral valve flow velocity (MVVmax) was0.90+0.20m/s, then was0.95±0.23M/s one month later, no significant difference, P value greater than0.05; the mitral flow velocity (MVVmax) was0.92±0.20M/s, when compared with preoperative, no significant difference, P value greater than0.05.preoperative pulmonary artery blood flow velocity (PVVmax)was1.5±0.4m/s, then1±0.4m/s one month later, and0.9±0.2m/s six month later,compared with preoperative, flows through the pulmonary artery blood flow velocity was slow, difference is apparent, P value less than0.01.preoperative flow through the aortic blood flow velocity (AVVmax)was1.11±0.17M/S, then1,13±0.20M/s one month later,1.14±0.16M/s six months later, compared with preoperative, no significant difference, P value greater than0.05. After Atrial septal defect closure, mitral valve reflux degree increased, postoperative reflux rate was larger, and the difference is apparent. and tricuspid valve regurgitation had one downtrend, but statistical analysis failed to reach positive results. combined with moderate or severe mitral valve regurgitation or tricuspid valve severe regurgitation, the incidence of postoperative severe complications was40%, and the preoperative mild mitral valve regurgitation or moderate tricuspid valve regurgitation, without serious postoperative complications, Patients with moderate or severe mitral valve regurgitation or tricuspid valve severe regurgitation are prone to severe postoperative complications,and the incidence of postoperative residual leakage rate:40%, while mild mitral valve regurgitation or moderate tricuspid valve regurgitation was25%, the two had significant difference, P value less than0.01. after operation, diameter of Right ventricular, right atrium decreased; left ventricular diameter increased, thickness of interventricular septum, mitral valve flow,aortic valve blood flow had no obvious change; pulmonary valve blood flow velocity was significantly reduced, mitral valve regurgitation degree become worse after closure of, and tricuspid valve regurgitation had no change; no valvular regurgitation or combined mild mitral valve regurgitation or moderate tricuspid valve regurgitation, there was no severe complication after surgery; combined with moderate or severe mitral valve regurgitation or tricuspid valve severe regurgitation after closure, was prone to serious complications, residual leakage probability was also high.conclusion:short period echocardiography reviews that transthoracic closure of atrial septal defect is safe and effective in patients who had no or mild mitral or the extents of tricuspid valve regurgitation below midrange,but in the patients who had midrange and above mitral valve regurgitation or severe tricuspid valve regurgitation have more opportunity to see mobility and motility,especially seldom and severe complications. |
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