Clinical Study On Short-term Efficacy And Safety Of Atrial Septal Defect After Interventional Closure

Objective(s):To study the safety of percutaneous atrial septal defect closure after short-term complications and short-term efficacy in our heart center。Method:In January 2019 to January 2020,in the first affiliated hospital of kunming medical university heart internal medicine line closure of atrial septal defects(200 patients as the research object,collect related clinical data,and the patients are short-term(less than a week after)follow-up,analyze the postoperative complications and curative effect,discussed all kinds of complications and the correlation of various factors.The specific contents include:1.Clinical data of patients were collected for statistical analysis,including basic information of patients,specific conditions of atrial septal defect(surrounding edge of the defect,whether the defect is multi-hole defect and combined with atrial septal occluderl),occluder size,postoperative complications,etc.2.The changes of cardiac ultrasound indexes(including left atrial diameter LA,left ventricular diameter LV,right atrial diameter RA,right ventricular diameter RV,left ventricular end-diastolic volume LVEDV,left ventricular end-systolic volume LVESV,and pulmonary systolic pressure PASP)were compared between preoperative and short-term postoperative,and the related factors affecting the changes were analyzed.2.Synchronous 12-lead electrocardiogram(12-lead electrocardiogram)was analyzed before and after surgery(within one week after surgery)to measure P wave dispersion,and the changes of P wave dispersion and related factors affecting the changes were analyzed;3.The incidence of complications in the short term after atrial septal defect closure was analyzed,and the factors of complications such as new arrhythmias and residual shunts were analyzed.Results:1.200 Baseline characteristics of the patients:59 males(29.5%)and 141 females(70.5%);There were 125 cases of Han(62.5%),75 cases of minority(37.5%,21 cases(10.5%)complicated with hypertension,4 cases(2%)complicated with diabetes,3 cases(1.5%)complicated with hypertension and diabetes,1 case(0.5%)complicated with cerebral infarction,and 6 cases(3%)complicated with AF.2.In patients undergoing atrial septal defect occlusion,compared with the cardiac ultrasound indexes before and one week after surgery,left ventricular end diastolic diameter(LVED),right atrial diameter(RAD),and right ventricular diameter(RVD)were reduced,and pulmonary systolic pressure(PASP)was decreased,with statistical significance(P<0.05);3.Analysis of the factors affecting the changes of cardiac ultrasound indicators:(1)Compared with the patients with the occlusion device diameter<30mm,the LVEDV and PASP of the patients with the occlusion device diameter>30mm were significantly reduced,and the differences were statistically significant.(2)The postoperative improvement of LVEDV and LVESV in patients with comorbidity Atrial septal defect(ASD)was significantly greater than that in patients without comorbidity,with statistical significance(P<0.05).4.The P-wave dispersion of Atrial septal defect(ASD)patients decreased significantly after occlusion,with statistical significance(P<0.05);The correlation analysis between the change of P-wave dispersion and other factors showed no statistical significance.5.Statistical analysis of postoperative complications:(1)Arrhythmia occurred in 22 patients(11%),including atrial premature beats in 6 cases(3%),degree I atrioventricular block in 2 cases(1%),complete right bundle branch block in 8 cases(4%),and sinus bradycardia in 4 cases(2%).2 cases of premature ventricular beats(1%);(2)11 cases(5.5%)had residual shunt;(3)Others:1 case(0.5%)presented arteriovenous fistula as a complication of vascular puncture,and 4 cases(2%)presented palpitation,chest tightness,headache and other discomfort.6.The changes of cardiac ultrasound index,P-wave dispersion,and other related factors were analyzed:(1)the difference between postoperative and preoperative LVESV was related to the new arrhythmia,that is,the difference between postoperative and preoperative LVESV in patients with arrhythmia was greater than that without arrhythmia,and the difference was statistically significant(P<0.05);(2)New incomplete right bundle branch block was associated with postoperative and preoperative pulmonary systolic pressure difference,and the difference was statistically significant(P<0.05).(3)There was no statistically significant difference between new arrhythmias and P wave dispersion and other related factors.7.Postoperative residual shunt was correlated with whether the atrial septal defect was complicated with bulge,whether the defect was multi-hole,and the residual edge of the lower lumen<5mm,with statistical significance(P<0.05).Conclusion(s):1.The first affiliated hospital of kunming medical university cardiovascular internal medicine structural heart disease professional team who suffer safe sealing treatment surgery:atrial septal defects(not present stopper off,aortic-right/left atrial fistula,severe arrhythmia and serious complications such as cardiac tamponade complications in sex room premature beat,incomplete right bundle branch block and tiny residual shunt more see;The small residual shunt was associated with short inferior lumen edge,porous defect and atrial septal bulge.2.Cardiac ultrasound indicators(LVEDV,RA,RV,LV,PASP)and P-wave dispersion were changed immediately after Atrial septal defect(ASD)occlusion(within one week);Atrial septal defect(ASD)patients with hypertension,diabetes mellitus,hypertension+diabetes mellitus,atrial fibrillation,cerebral infarction,as well as patients with large defect(>30mm gap)had significant changes in cardiac ultrasound indexes in the short term after occlusion.3.Special type of atrial septal defect:Atrial septal defect(ASD)with diameter≥36mm,inferior residual edge and/or posterior inferior edge<5mm,non-occlusion is an absolute contraindication;However,the residual edge of the lower cavity<5mm was associated with fine residual shunt.