Clinical Study Of Percutaneous And Peratrial Device Closure Of Multi-Hole Atrial Septal Defect Under Exclusive Transesophageal Echocardiographic Guidance

Purpose:Through the study of percutaneous and peratrial device closure of Multi-Hole Atrial Septal Defect(MHASD)under exclusive transesophageal echocardiographic guidance,this effort aims to evaluate the safety and effectiveness of percutaneous and peratrial device closure of MHASD.To explore the clinical application of Inter-Defect Septal Puncture Technique,and further systematize the occlusion method of MHASD.Method:From July 2005 to December 2021,187 patients underwent MHASD occlusion.There were 47 patients who underwent percutaneous device closure of MHASD under the exclusive guidance of transesophageal echocardiography.From 140 patients who underwent peratrial MHASD closure in our hospital,59 patients with age and MHASD configuration similar to the percutaneous group were selected as the control group(peratrial group).The operation success rate,closure strategy,operation time,intracardiac manipulation time,residual shunt,postoperative hospitalization days,short and medium-term follow-up and other indicators were compared and analyzed.Result:All 106 patients were operated successfully.The success rate of percutaneous group was 94%(44/47),three failed patients were successfully occluded by peratrial approach.The success rate of peratrial group was 100%(59/59).The reason of failure in percutaneous group:the ASD edge to the inferior vena cava or superior vena cava was only 5mm,and the occlude was unstable after anchoring.The number of patients successfully using the method of "Occlude the big and squeeze the small","Occlude the middle and cover the peripheral","Inter-defect septal puncture technique" and "Double device implantation" in percutaneous group or peratrial group was 24/22,19/15,0/12 and 2/12,respectively.The operation time was 32.21 ± 4.82 min in percutaneous group and 64.84 ± 20.42 min in peratrial group.The intracardiac manipulation time was 24.75 ± 5.59 min in percutaneous group and 18.74 ± 8.28 min in peratrial group.The hospital stay after operation was 2.62 ± 0.53 days in percutaneous group and 4.27 ± 0.76 days in peratrial group.Compared with preoperative data,at two days and six months postoperative follow-up,the diameter of right atrium and anterior posterior diameter of right ventricle decreased,and the diameter of left atrium and end diastolic diameter of left ventricle increased(P<0.05).In the percutaneous group,there were 11 cases of immediate residual shunt,5 cases of residual shunt at the one-year follow-up.In the percutaneous group,there were 12 cases of immediate residual shunt and 3 cases of residual shunt at the one-year follow-up.All residual shunts were less than 3mm.Conclusion:Percutaneous or peratrial closure of MHASD under exclusive transesophageal echocardiographic guidance is safe and effective,with good surgical outcome and less complications.Every ASD should be evaluated in detail before operation in order to choose an minimally invasive occlusion strategy.The following methods of "Occlude the big and squeeze the small"," Occlude the middle and cover the peripheral",and "Inter-defect septal puncture technique" and "Multiple device implantation" can be used as step-up methods in sequence for ASD device closure.The sequence of approach can be helpful to achieve minimally invasive occlusion to the greatest extent.