| OBJECTIVE:The objective of this research is to retrospectively contrast research on atrial septal defect(ASD)and ventricular septal defect(VSD),by utilizing ultrasound-guided closure with the traditional surgery in our hospital.Furthermore,the research also aims at exploring the indications,safety,and feasibility of ultrasound-guided closure,and providing the basis for clinical treatment selection.METHODS:A collection of 64 medical cases of ASD and VSD(45 cases of traditional surgery:38 cases of ASD,7 cases of VSD and 19 cases of ultrasound-guided occlusion:15 cases of ASD,4 cases of VSD)were treated in the cardiac surgery department of Su Bei Hospital from 2013.07 to 2018.07.All the selected cases were confirmed and contraindicated by preoperative transthoracic echocardiography(TTE),routine examination,electrocardiogram,chest CT or positive and lateral chest radiography,and some elderly patients were routinely excluded from coronary artery disease by preoperative coronary angiography.As this experiment is a retrospective analysis,the inclusion criteria for cases is as follows:1.Secondary ASD and ventricular septal defect were not associated with other heart diseases requiring surgical treatment.2.The preoperative and postoperative nursing records,the course of the disease and other data of the selected patients can be found truthfully,and the review of echocardiography is completed in our hospital.3.All the plugging devices in the occlusion group were made of Shanghai Shape Memory Alloy Materials Company.Exclusion criteria:1.Incomplete clinical data of the patient or the examination was conducted by other hospitals;2.Patients with other complications A deformity requiring surgical treatment.Two groups in preoperative condition(gender,age,weight,septal defect size...),general intraoperative(operation time,length of incision,Cardiac Pulmonary Bypass(CPB)and Aortic occlusion(AO)...),and postoperative recovery,(postoperative bed time,success rate of surgery,postoperative hospitalization days...)and postoperative complications(residual leakage,pneumothorax,pericardial effusion and pleural effusion...)were compared.Then,Statistical data were all processed by SPSS 21.0 statistical software.RESULTS:There was a difference in preoperative body weight between the traditional surgery group and the occlusion group.Body weight in occlusion group was(49.5±22.2)Kg,while in the conventional treatment group was(55.5±15.0)Kg,Age of the occlusion occlusion group was(30.3±20.9)years old,which of the traditional operation group was(36.7±17.7)years old.Preoperative echocardiography showed that the diameter of defect in occlusion group was(ASD:9.2±3.0 mm,VSD:2.4±0.6 mm)and traditional operation group was(ASD:22.2±9.9 mm,VSD:9.1±4.7 mm).The traditional operation group received routine operation under general anesthesia and cardiopulmonary bypass,the aorta was blocked during the operation and platelet was transfused according to the coagulation index to improve the coagulation after operation The amount of bleeding in the occlusion group was(15.8±9.9)ml,that in the traditional operation group was(358.7±187.2)ml,and there was no blood transfusion in the occlusion group,while in the traditional group the volume of blood transfusion was(719.4±452.6)ml.After operation,the patients were routinely observed in the intensive care department.The ventilation time of ventilator in the occlusion group was(5.5±4.2)h,and that of the traditional operation group was(20.5±7.0)h.There was no death in both groups,one patient in the group failed to occlude and open thoracic surgery was performed at another time.The success rate of operation was 94.8%,which was lower than that of surgical operation(100%),The reason was that the margin of aortic valve defect was insufficient.One case underwent reoperation for hemostasis due to massive hemorrhage after operation in the traditional operation group.There was no residual shunt in the occlusion treatment group;In the traditional operation group a small residual shunt was found,The residual shunt rate was 4.4%.All patients were treated conservatively and followed up regularly.Complications such as pneumothorax,incision liquefaction and pleural effusion in surgical group were significantly higher than those in interventional group.There were statistical differences in Postoperative hospitalization days and hospitalization expenses between the two groups.CONCLUSION:Compared with traditional surgical operations,atrial and ventricular septum therapy were guided by ultrasound does not need to destroy the sternal structure,carry out extracorporeal circulation,or improve the patient's blood coagulation without blood transfusion,so the operation is safer and less risky.Compared with the traditional surgical incision,the ultrasound-guided sealing has smaller incision size,no radiation exposure risk and no postoperative fat liquefaction,which is more in line with the contemporary pursuit of beauty and can reduce the patient's physical and mental burden to a certain extent.The occlusion group had shorter operation time,faster postoperative recovery and was superior to the surgical group in terms of indications.With the improvement of sealing technology and the progress of sealing materials,the Sonically-guided occlusion therapy will certainly provide a more ideal scheme for the treatment of congenital heart disease. |
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