The Study Of Relationship Between Secundum Atrial Septal Defect Diameters And The Sizes Of Occluders In Interventional Therpay

OBJECTIVE:To explore the contribution of transthoracic echocardiography (TTE) in transcatheter closure of secundum atrial septal defects (ASD).To explore the relationship between the ASD dianmeters estimated by TTE and the selected atrial septal occluders (ASO) sizes before and after deployed, in order to help the selection of the most suitable ASO.METHODS:The first part:205patients with complete informations were recruited from Pediatric Cardiology Department of Shandong provincial hospital.205patients were divided into three groups based on their largest ASD diameters:65subjects (5mm≤ASDdiameters<12mm) in group A;76subjects (12mm<ASDdiameters <20mm) in group B;64subjects (ASDdiameters≥12mm) in group C. To analyse the relationships between the ASD diameters estimated by TTE and the the selected atrial septal occluders (ASO) sizes in three groups with statistical tests.The second part:144patients with complete informations were recruited from Pediatric Cardiology Department of Shandong provincial hospital, ASO were deployed successfully in all patients. The diameters of ASO image were measured by catheter calibration technology. To analyse the relationship between the ASD diameters estimated by TTE and the selected atrial septal occluders (ASO) sizes after deployed by Linear correlation and Linear regression analysis. RESULTS:The first part:(1) ASO were successfully deployed in193patients(94.1%),65(100%) in group A,73(96.1%) in group B,55(85.9%) in group C.(2) ASD diameters in group A, B and C were8.89±1.86mm,15.16±2.06mm and24.69±4.01mm, respectively. The selected atrial septal occluders (ASO) sizes before deployed were10.73±2.31mm,18.38±3.60mm and28.84±4.80mm,respectively.(3) The difference between diameters of ASD and ASO in group A, B and C were1.87±1.49mm,3.33±2.32mm and4.52±3.19mm.(4)95%confidence interval of the difference between diameters of ASD and ASO in group A, B and C were1.50～2.24mm,2.79～3.88mm and3.66-5.38mm, respectively. The90th percentile of the difference between diameters of ASD and ASO in group A, B and C were4.0m、7.0mm、10.0mm.The second part:(1) The diameters of ASD, the selected atrial septal occluders (ASO) sizes before and after deployed were15.46±6.65mm,18.36±7.83mm and15.44±6.63mm.(2) Correlation coefficients were0.948between the ASD diameters estimated by TTE and the selected atrial septal occluders (ASO) sizes before deployed; The liner regression equation were that the selected atrial septal occluders (ASO) sizes before deployed=1.116×ASD diameters+1.110.(3) Correlation coefficients were0.936between the ASD diameters estimated by TTE and the selected atrial septal occluders (ASO) size after deployed; The liner regression equation were that the selected atrial septal occluders (ASO) sizes after deployed=0.932xASD diameters+1.030.CONCLUSIONS:(1) With multiple cross sectional views, TTE offers a reliable technique for determination of ASD and guidance of ASO positioning and deployment.Transcatheter ASD closure has a high success rate especially in patients with ASD<20mm. The difference between ASO and ASD could be0-4mm in patients with ASD<12mm,1～7mm in patients with12mm<ASD<20mm,2～10mm in patients with ASD>20mm.(2)The liner regression equation were that the selected atrial septal occluders(ASO) sizes before deployed=1.116×ASD diameters+1.110. The liner regression equation were that the selected atrial septal occluders (ASO) sizes after deployed=0.932×ASD diameters+1.030.