Objective To evaluate the efficacy and safety of transthoracic minimally invasive occlusion operation for the treatment of congenital atrial and ventricular septal defects. Methods The clinical data of 88 patients who underwent surgical occlusion operation from December 2015 to February 2017 were summarized. There were 52 males and 36 females, aged 6.8±7.5 years ranging from 1.6 to 24.0 years. All the patients were followed up by ultrasound and electrocardiogram at postoperative 3, 6 and 12 months. The efficacy of minimally invasive thoracotomy was analyzed by statistical methods. Results The patients were followed up for 3-15 (6.8±2.3) months, and the follow-up rate was 92.0%. Ultrasound showed occluder fixed well and no residual shunt, valve regurgitation, thrombosis or other complications occurred. The heart was reduced, the ejection fraction was greater than 55%, and heart function rating for all patients was grade Ⅰ. Conclusion Transthoracic mini-invasive surgical occlusion of atrial and ventricular septal defects is safe and effective. The short and middle-term effect is satisfying. It can be widely used in clinical, but multi-center and long-term follow-up and assessment still need to be carried out.
ObjectiveTo investigate clinical outcomes of isolated atrial septal defect (ASD)repair on the beating or non-beating heart through minimally invasive right axillary approach. MethodsForty-five patients underwent isolated ASD repair through minimally invasive right axillary approach in Research Institute of Surgery, Daping Hospital of the Third Military Medical University from September 2009 to August 2011. According to different surgical techniques, all the patients were divided into a beating-heart group and a non-beating heart group. In the beating-heart group, there were 22 patients including 13 males and 9 females with their mean age of 3.2±2.1 years and body weight of 13.1±4.0 kg. There were 20 patients with ostium secundum ASD and 2 patients with ostium primum ASD. Mean ASD diameter in the beating-heart group was 12.2±5.1 mm. In the non-beating heart group, there were 23 patients including 14 males and 9 females with their mean age of 3.5±2.5 years and body weight of 12.9±3.3 kg. There were 18 patients with ostium secundum ASD, 3 patients with sinus venosus ASD, and 2 patients with ostium primum ASD. Mean ASD diameter in the non-beating heart group was 11.6±4.7 mm. Serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST)and highly sensitive cardiac troponin I (cTnI)were examined preoperatively, after weaning from cardiopulmonary bypass (CPB), 6 hours and 24 hours postoperatively. ResultsThere was no in-hospital death. Postoperatively, 1 patient had right atelectasis and another patient had right pneumothorax. CPB time and operation time of the beating-heart group were significantly shorter than those of the non-beating heart group (P < 0.05). There was no statistical difference in intraoperative blood transfusion, mechanical ventilation time, length of postoperative ICU stay or hospital stay, chest drainage within 24 hours postoperatively, or postoperative cardiac function between the 2 groups (P > 0.05). Preoperative levels of CK, CK-MB, AST and cTnI were all within the normal limit, and there was no statistical difference between the 2 groups (P > 0.05). After CPB, CK, CK-MB, AST and cTnI levels increased in both groups, but increased significantly greater in the non-beating heart group (P < 0.05). Postoperative levels of CK, CK-MB, AST and cTnI of the beating-heart group were significantly lower than those of the non-beating heart group (P < 0.05). ConclusionIsolated ASD repair on the beating heart via minimally invasive right axillary approach is a safe and cosmetic procedure with shorter operation time and less myocardial injury.
ObjectiveTo explore the key points, indications and safety of trans-jugular transcatheter closure of atrial septal defect (ASD) in infants.MethodsThe clinical data of 53 infants with ASD from January 2017 to May 2019 in our hospital were retrospectively reviewed. There were 20 males and 33 females with the age of 1.2 (0.5-2.9) years, and body weight of 9.0 (6.8-10.6) kg. The ASD diameter was 9.8 (8.0-14.0) mm. Thirty-one patients were treated under the guidance of transesophageal ultrasound (TEE), and the other 22 patients under the guidance of transthoracic echocardiography (TTE). We used the steerable curved sheath through the internal jugular vein under the guidance of echocardiography, and the average occluder size was 13.5±4.5 mm.ResultsAll of the 53 patients were successfully occluded, and none of them changed to radiation-guided or transthoracic surgery. Postoperative hospital stay was 3.35±0.70 d. There was no complication such as peripheral vascular injury, occluder malposition or displacement, serious arrhythmia or pericardial effusion. The patients were followed up for 14.3±5.1 months without arrhythmia, residual shunt, occluder malposition or displacement or thrombus.ConclusionEchocardiography-guided trans-jugular closure of ASD for infants with low weight and large ASD shunt or patients with inferior vena cava abnormalities not suitable for femoral vein treatment, not only overcomes the radiation risk of radiation guidance, but also maintains the advantages of minimal invasiveness and safety, providing a new treatment option for such patients.
ObjectiveTo systematically review the efficacy and safety of totally thorascopic (TT) and median sternotomy (MS) approaches for atrial septal defect repair (ASDR). MethodsDatabases including The Cochrane Library (Issue 2, 2016), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to June 2016, to collect randomized controlled trials or cohort studies about TT vs. MS approaches for ASDR. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 11 cohort studies involving 687 patients were included with 305 patients in the TT group, and 382 patients in the MS group. The results of meta-analysis showed that: The TT group had shorter postoperative ventilation time (MD=-1.49, 95%CI -2.27 to -0.71, P=0.000 2), postoperative ICU stay time (MD=-7.30, 95%CI -12.07 to -2.53, P=0.003), hospital stay time (MD=-2.06, 95%CI -2.80 to -1.32, P<0.000 01) and less postoperative drainage (MD=-199.83, 95%CI -325.96 to -73.70, P=0.002) than the MS group. But the bypass time (MD=9.42, 95%CI 1.55 to 17.30, P=0.02) and aortic clamping time (MD 6.78, 95%CI 3.48 to 10.07, P<0.000 1) of the TT group were significantly longer than those of the MS group. ConclusionCompared with MS, TT can significantly reduce the length of postoperative ventilation, postoperative ICU stay, hospital stay and postoperative drainage. But there are risks of prolonged bypass time and aortic clamping time in the TT group. Due to the quantity and quality of the included studies, the above conclusions still needs to be verified by carrying out more studies.
Objective To investigate the surgical treatment of adult secondary atrial septal defect with paroxysmal atrial fibrillation. Methods We retrospectively analyzed the clinical data of 84 patients with adult secondary atrial septal underwent surgical treatment in Beijing Anzhen Hospital from January 2002 through May 2013. There were 31 males and 53 females at mean age of 56.3 (24-72) years. Eleven patients were treated by cardiopulmonary bypass operation with 6 patients by radiofrequency catheter ablation simultaneously. Seventy three patients were implanted with septal defect closure with 52 patients by radiofrequency ablation simultaneously. Rhythm of the heart was detected at the immediate postoperative period, 7 days, 3 months and 6 months after the operation. Results No preoperative death, thoraecotomy and no arrhythmic complications in all the patients no matter with or without RF occurred. In the patients with cardiopulmonary bypass operation, the time of aortic occlusion was 35.21±12.32 min, the cardiopulmonary bypass time was 45.67±16.93 min, and the ICU observation time was 11.87±12.36 hours. In the patients with septal defect closure implanted, ICU observation time was 10.93+13.67 hours. The incidences of atrial fibrillation in the patients with radiofrequency ablation on postoperative 7 days，3 months and 6 months were lower than those in the patients without radiofrequency ablation (P<0.05). Conclusion For adult secondary atrial septal defect patients with paroxysmal atrial fibrillation, no matter cardiopulmonary bypass operation or septal defect closure implanted, radiofrequency ablation at the same time is safety and can reduce incidence of recurrence of atrial fibrillation.
ObjectiveTo evaluate the advantages and disadvantages of parasternal minimally incision surgery over median sternotomy to treat atrial septal defect (ASD) patients. MethodsWe retrospectively analyzed the clinical data of 55 ASD patients received ASD closure under cardiopulmonary bypass (CPB) in Department of Cardiovascular Surgery, West China Hospital from November 2010 through March 2014. There were 16 males and 39 females with an average age of 25.8 (range, 9-56 years). All the patients were divided into two groups depending on different surgical approach:a median sternotomy group (a MS group, 15 patients)and a parasternal minimally incision group (a PMI group, 40 patients). There was no statistical difference in age, gender, weight, cardiac function classification (NYHA), and atrial septal defect diameter between the two groups (P>0.05). We analyzed the clinical data of the patients and followed up for 6 months. ResultsAfter operation, no death occurred in the two groups. One patient in the MS group prolonged hospitalization due to poor postoperative heart function. One patient in the PMI group prolonged hospitalization because of pulmonary infection. Patients in the PMI group had longer operation time (P=0.007) and cardiopulmonary bypass (CPB) time (P < 0.001), higher cost in hospital (P=0.040), less intraoperative blood loss, less postoperative drainage volume on the first day (both P < 0.001). There was no statistical difference in aortic clamp time (P=0.500) mean hospital stay (P=0.290) after operation between the two groups. To eliminate the interference of the learning curve, there was no statistical difference in operation time (P=0.275) and hospitalization cost (P=0.188) between the two groups. While there was a statistical difference in CPB time between the two groups (P=0.007). There was no remnant shunts or wound complications in the two groups at the end of following up for 6 months. More patients in the PMI group could engage in non-strenuous activities with a statistical difference (P < 0.001). ConclusionParasternal minimally incision in the treatment of atrial septal defect is safe, effective, minimally invasive, with easy operation and shorter learning curve. It can be used as an important part of minimally invasive treatment procedure of congenital heart disease.
Objective To evaluate long-term outcomes of surgical closure of atrial septal defect (ASD) and combined surgical radiofrequency ablation for atrial fibrillation (AF). Methods A total of consecutive 15 patients with ASD undergoing surgical closure of ASD and combined surgical radiofrequency ablation in our department between March 2003 and April 2015. There were 7 males and 8 females at an average age of 47.1±10.8 years ranging from 16 to 62 years. Retrospective analysis and follow-up were performed to evaluate long-term success rate freedom from AF after surgery. Results All patients recovered and discharged, and no patient suffered death or stroke. The duration of follow-up was from 3 to 136 months for all patients. Success rate freedom from AF at 1, 3, 5 and 10 years was 81.3%, 75.0%, 68.8% and 61.1%, respectively. During follow-up, there was no death or stroke. One patient required permanent pacemaker implantation. Conclusion Concomitant surgical closure of ASD and biatrial radiofrequency ablation is safe and effetive with better long-term outcomes. It is necessary to perform the two procedures together for ASD patients.
ObjectiveTo summarize clinical outcomes of atrial septal defect (ASD)occlusion for patients with ASD and tricuspid regurgitation (TR). MethodsBetween July 2006 and January 2012, 98 patients with ASD and TR under-went ASD occlusion in Xinhua Hospital, Shanghai Jiaotong University School of Medicine. There were 36 male and 62 female patients with their age aging from 2 months to 80 years. All ASD were secundum ASD with their diameter of 3-23 mm. There were 60 patients with mild TR, 28 patients with moderate TR, and 10 patients with severe TR. All the patients received ASD closure without specific management for TR, including 51 patients under digital subtraction angiography (DSA), 46 patients via a minithoracotomy approach, and 1 patient guided by transthoracic echocardiography. All the patients were followed up with echocardiography to evaluate changes of TR after ASD closure. ResultsThere was no in-hospital death. ASD occlusion was not successful in 1 patient who was found to have residual ASD shunt on the third postoperative day. Another patient underwent reexploration for abnormal bleeding on the third postoperative day. All the other patients had uneventful postoperative recovery. Eighty-four patients were followed up for 1-64 (26.56±21.35)months. During follow-up, the patient who have residual ASD shunt on the third postoperative day received open chest repair 6 months after discharge. TR of 73 patients (86.90%)improved in different degrees. Preoperative severe TR in 10 patients changed into mild TR in 8 patients, moderate TR in 1 patients and still severe TR in 1 patient. Preoperative moderate TR in 26 patients changed into none TR in 6 patients, mild TR in 18 patients and still moderate TR in 2 patients. Preoperative mild TR in 48 patients changed into none TR in 40 patients and still mild TR in 8 patients. ConclusionFor patients with ASD and TR, conservative treatment strategy is recommended. Simple ASD closure can provide satisfactory clinical outcomes, and also avoid adverse complications of cardiopulmonary bypass including myocardial injury and lung injury.
Objective To analyze the influencing factors and outcomes of atrial septal defect (ASD) and ventricular septal defect (VSD) occlusion guided by echocardiography. Methods We retrospectively analyzed the clinical data of 188 patients receiving transthoracic and percutaneous transcatheter closure of ASD and VSD from July 2009 to July 2017 in our department, including 74 males and 114 females, aged 13.48±13.53 years ranging from 1 to 65 years. Results Fifty-three ASD patients accepted transthoracic closure surgery, of whom 4 patients were difficult to close and 6 patients failed to close; 24 patients underwent percutaneous transcatheter ASD occlusion surgery, of whom 3 were difficult to close and 1 failed in occlusion; 108 VSD patients implemented transthoracic closure surgery, of whom 10 patients were difficult to close and 5 patients failed in closure; 9 VSD patients underwent percutaneous transcatheter closure, of whom 5 failed and then was converted to transthoracic closure. Our study showed that too large or too small aperture was the independent risk factor. Two kinds of closure surgery had their own advantages and disadvantages. The special type of VSD was the influencing factor of transthoracic closure. Conclusion When the ASD diameter≥25 mm, transthoracic closure is the best choice to avoid the use of large occluder. When the ASD diameter<25 mm, percutaneous closure surgery is the best choice. When the ASD diameter≥35 mm, it is best to give up the closure operation. Technical improvements can significantly raise the closure success rate of the subarterial VSD. For the entry diameter>10 mm and membranous aneurysm with multi-break, occlusion surgery should be avoided in VSD.
ObjectiveTo assess the feasibility and safety of percutaneous transcatheter closure of atrial septal defect (ASD) guided by transthoracic echocardiography (TTE) in outpatients.MethodsFrom December 2016 to June 2018, 50 simple ASD patients underwent TTE-guided transcatheter closure in the outpatient operating room of our hospital (a TTE group) including 22 males and 28 females at the age of 16-48 (27.40±6.95) years. Fifty patients with simple ASD treated with the guidance of conventional fluoroscopy during the same period were treated as a control group, including 22 males and 28 females at the age of 15-48 (28.58±6.96) years. Both groups were re-examined by TTE during follow-up at 1 month, 3 months, 6 months and 1 year.ResultsThe mean age, body weight, the size of ASD and occluder and success rate had no statistical difference between the two groups (P>0.05). Compared with the control group, the TTE group had significantly lower mean operation time (P<0.01) and less cost (P<0.01) since patients need not to be hospitalized. No related complications were found in the TTE group during follow-up.ConclusionPercutaneous transcatheter closure of ASD guided by TTE appears safe and effective for outpatients, and can significantly reduce the cost.