| Objective:To compare the echocardiography and clinical results from patients received occlusion of secundum ASD via percutaneous under single TTE and traditional X-ray guidance closure of secundum ASD and investigate the feasibility and safety of occlusion via single transthoracic echocardiographic guidance.Methods: According to the same inclusion criteria,106 patients from February 2017 to June 2017 in Xinjiang cardiovascular and cerebrovascular disease hospital with secundum atrial septal defect were divided into two groups(single TTE and traditional X-ray guidance group,53 cases each group),basing on transcatheter closure with Amplatzer septal occluder.Successful rate,complications,residual shunt rate,intracardiac manipulation time,total operation time,the postoperative hospitalization days,hospitalization expense were compared between the two groups.The clinical follow-up study was conducted by TEE and ECG examination at 1,3,6 and 12 months after the procedure.The secondary arrhythmia and heart size(LA diameter,LV diastolic diameter,the RA diameter,RV diameter,Left heart ejection fraction(LEF%)were compared to investigate the feasibility and safety.Results:There were 106 ASD patients were with successful treatment in the two groups,including 39 males and 67 females,average age(7.47±3.91)years,average body weight(23.07±7.61)kg.All patient was cured and organic heart murmur disappeared and no obvious residual shunt was found after the postoperative follow-up.No patients suffered from organic heart murmur,pericardial effusion,occluder malposition,arrhythmia and valve regurgitation.TTE guidance and X-ray guidance group of patients in the gender(males 17 VS 22,females36 VS 31,P = 0.314),age(7.13±3.77 VS 7.81±4.06,P = 0.374),body weight(22.13±7.48 kg VS 24.00±7.70 kg,P = 0.208),ASD diameter(9.08±6.00 mm VS 10.42±5.50 mm,P = 0.237),Successful rate(49/53 VS 51/53,P = 0.401),the immediate postoperative residual shunt(4/53 VS 5/53,P = 0.341),complications(4/53 VS 2/53,P = 0.712),postoperative hospitalization days 3.02±0.31 days VS 2.88±0.47 days,P = 0.090),hospitalization cost(23441.19±1631.21 yuan VS 23576.22±1094.81 yuan,P =0.624)there was no statistically significant difference(P >0.05).The TTE guidance treatment group in intracardiac manipulation time(23.48±7.51 min VS 19.79±5.88 min,P=0.006)and the total operation time(42.33±12.61 min VS30.77±6.20,P <0.000)were significantly longer than that in X-ray guidance transcatheter treatment group.Patients received postoperative ECG and TEE examination follow—ups in 7 days,the first month,the third month and the sixth month after procedure.No closure related arrhythmia was observed in all postoperative patients.TEE revealed the size of the heart(TTE guidance group:RA(34.17±6.26mm)reduced to(29.51±4.60mm),RV(32.92±5.44mm)reduced to(29.08±4.32mm),LA(24.92±5.93mm)increases to(26.39±4.95mm),LVd(34.11±6.64mm)increases to(36.16±4.88mm);X-ray guidance group:RA(35.94±7.27mm)reduced to(30.00±5.01mm),RV(33.98±7.04mm)reduced to(30.04±5.53mm),LA(25.09±5.72mm)increases to(26.40±4.35mm),LVd(35.58±5.34mm)increases to(37.98±4.77mm)gradually returned to normal.All TTE examination revealed Left heart ejection fraction(LEF%)(TTE guidance guidance group:the measurements(60.02±0.83?60.25±0.82?60.10±0.85?60.14±0.99?60.36±1.91);X-ray guidance group:the measurements(60.09±1.24?60.23±1.18?60.37±1.31?60.16±1.31?60.48±1.35)were normal.To compare the heart size?LEF% in TTE and X-ray group,there was no statistically significant difference(P >0.05).Conclusion: TTE can be used to monitor the surgical procedure and provide a new guidance method and thinking for the minimally invasive treatment of ASD,affording more options for clinician.Single TTE and traditional X-ray guidance interventional device closure simple central type ASD indications were similar.Through accurate preoperative assessment,strictly control the indications,intraoperative ultrasound doctors meticulous and comprehensive guide,surgery doctors careful operation,simple TTE guided percutaneous intervention to closure also has a high success rate and can avoid the occurrence of serious complications.There was no serious complications in recent follow-up,hemodynamic improvement and morphological structurewas significantly improved than before.The two kind of operations were similar in safety and efficacy.This kind of ultrasonic guided technologies,no heavy protective equipment,no thoracotomy,no general anesthesia,no endotracheal intubation,no radiation,no contrast agent,protect patients and doctors,protect the environment,were worthy of clinical promotion.Objective:This study was performed to evaluate the perioperative related factor for failure of surgery under single TTE guidance percutaneous intervention closure of secundum ASD and provide advise on the reasonable choice of surgical program.Methods: According to the same inclusion criteria,191 patients were chosen from December 1,2015 to September 1,2017 in Xinjiang cardiovascular and cerebrovascular disease hospital who were received the percutaneous intervention closure of secundum ASD under single TTE guide.The selected patients were divided into two groups according to whether changed the guiding methods intraoperative or occurred complications intraoperative and postoperative.This study was based on previous literature and actual clinical needs,gender,age,weight,BMI,the size of heart,the type of ASD(multiply or single fenestrated),the peripheral condition of ASD(soft or tough verges),the quality of TTE image(excellent or disappointing),intraoperative measurement of ASD diameter,the diameter of closure(Amplatzer),closure release times,intracardiac manipulation time,the total operation time and other related potential factorshad had done statistical analysis.Results:All patient was cured and organic heart murmur disappeared.The percutaneous intervention surgical success group including 171 cases and the failure group including 20 cases.The two groups in the gender(males 64 VS 8,females 107 VS 12,P= 0.822),age(11.96±12.76 VS 13.53±13.95,P = 0.608),body weight(29.10±17.99 kg VS 31.90±19.93 kg,P = 0.516),BMI(17.57±4.10 VS 17.77±5.01,P =0.841),the size of the heart(LA 24.77±5.54 mm VS 24.00±5.55 mm,P =0.559,LVd 33.74±6.01 mm VS 35.15±6.96 mm,P =0.329,LVs 20.56±4.27 mm VS 21.85±6.18 mm,P =0.227,RA 33.48±6.76 mm VS 34.05±7.25 mm,P =0.723,RV 31.78±6.88 mm VS 32.55±7.76 mm,P =0.643),the type of ASD(multi-fenestrated 16 cases,single fenestrated 155 cases VS Multi-fenestrated 1 cases,single fenestrated 19 cases,P =0.517),intraoperative measurement of ASD diameter(9.67±5.61 mm VS 10.53±7.53 mm,P =0.537),the diameter of closure(Amplatzer,15.73±6.26 mm VS 17.05±7.74 mm,P =0.384)there was no statistically significant difference(P >0.05).In the peripheral condition of ASD(soft verges 13 cases,tough verges 158 cases VS soft verges 15 cases,tough verges 5 cases,P <0.00),the quality of TTE image(excellent 152 cases,disappointing 19 cases VS excellent 9cases,disappointing 11 cases,P <0.00),closure release times(once 97 cases,twice 61 cases,thrice13cases VS once 4cases,twice 6cases,thrice 10 cases,P <0.00),intracardiac manipulation time(20.58±8.74 min VS 38.05±14.32 min,P <0.00),the total operation time(41.54±16.63 min VS 60.10±15.55 min,P <0.00),there was statistically significant difference(P >0.05).The peripheral condition of ASD,the quality of TTE image,closure release times,intracardiac manipulation time,the total operation time were for Logistic regression analysis.the peripheral condition of ASD(B=-1.771,P <0.05,Wald value 4.481),the quality of TTE image(B=1.937,P <0.05,Wald value 4.675),closure release times(B=1.204,P <0.05,Wald value 5.427),intracardiac manipulation time(B=0.112,P<0.05,Wald value 7.126).The Logistic regression equation was used for the retrospective verification,and the total conformance rate of the patients in this group was 96.3%.Conclusion:The operation results were influenced by multiple factors.The peripheral condition of ASD,the quality of TTE image,closure release times and intracardiac manipulation time were the main factors that affect the outcome of surgery under single TTE guidance percutaneous intervention closure of secundum ASD.Through accurate preoperative assessment,strictly control the indications,clinician standard operation and worked closely together can improve the success rate of surgery. |
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