Clinical Research Of Intraoperative Device Closure Of Congenital Heart Disease Through Minimally Incision Under Transthoracic Echocardiographic Guidance

Objective:This study aimed to investigate the the feasibility and safety of intraoperative device closure of congenital heart disease with domestically made device under transthoracic echocardiography(TTE) guidance through minimally incision. And this study also explore the effects of this technique on cardiac remodeling and heart function. Methods:31 cases with congenital heart disease(CHD) who hospitalized in our hospital between September 2012 and November 2014 were enrolled in this study.12 of which were males and 19 females, aged range,1～66 years (mean 15.2±17.7 years). All cases were diagnosed by physical examination and TTE.10 were ventricular septal defect(VSD)(mean diameter,5.4 ± 1.35mm) and 21 were atrial septal defect(ASD)(mean diameter,11.4±5.3mm). All patients underwent closure through minimally incision with domestically made device by the guidance of TTE without cardiopulmonary bypass. To ensure that no residual shunt and valvular dysfunction after release device with the reassess of TTE. Aspirin or dipyridamole was given for anticoagulation for 3 months after the procedure. And the data of left ventricular diameter (LV), left atrial diameter (LA), right atrial diameter(RA), right ventricular diameter (RV) and left ventricular ejection fraction(EF) were analyzed which were measured before the closure and on the 3rd month after the closure by TTE. Results:3 months after closure, compared with pre-VSD closure, LA was significantly smaller by [(31.87±6.91)mm vs. (27.13±7.81)mm, P<0.05]. LV significantly decreased after the closure by [(33.98±7.43)mm vs. (29.02±6.63)mm, P<0.05] and RV increased on the 3rd month by [(20.11±4.28)mm vs. (22.97±3.65)mm, P<0.05]. EF(%) increased after the closure by [(59.11±4.23) vs. (62.14±3.57),P<0.05]. In ASD group, RA and RV continuously decreased after the closure, by [(36.62±3.91)mm vs. (32.92±4.57)mm, P<0.05] and [(21.41±2.39)mm vs. (18.19±3.62)mm, P<0.05] respectively. LV increased on the 3rd month by [(35.11±3.86)mm vs. (39.15±6.52)mm, P<0.05].EF(%) significantly increased by [(59.72±8.17) vs. (65.64±7.89), P<0.05] Four cases appeared mild mitral valve regurgitation postoperatively. Followed up for 1-6 months after surgery, most of these cases were not presented residual shunt and valvular regurgitation, obvious arrhythmia, thrombosis, device failure and other related complications, excluding 1 case of atrial septal defect appeared residual shunt (diameter 3.5mm). Conclusions: TTE can monitor the whole procedure through multi-slice and provide an alternative method for the guidance of device closure for CHD through minimally incision, which also provide more choices for clinical treatment. Minimally incisive transthoracic device closure of CHD using a domestically made device under transthoracic echocardiographic guidance without the need of cardiopulmonary bypass is safe and feasible. This technique may effectively improve the cardiac remodeling in ASD and VSD patients in the short-term follow-up.