ABSTRACT
Objective To evaluate the efficacy and safety of mini-incision transthoracic occlusion for patent ductus arteriosus(PDA)in adults.Methods From November 2005 to May 2007,10 adult patients(occlusion group)received mini-incision transthoracic occlusion of PDA under the guidance of transesophageal ultrasonography in our hospital.A 3-to 5-cm incision was made at the second intercostal space adjacent to the left sternum to expose the pulmonary aorta.Afterwards,a catheter was introduced into the pulnonary artery,and then delivered into the aorta via the PDA under the guidance of ultrosonograohpy.An occluder of 4 to 6 mm larger than the PDA in diameter was then released to engage on the defect.Twenty patients who recieved on-pump surgery were set as a control group.Results Compared with the control,patients in the occlusion group had a smaller incision [(3.6?1.6)cm vs(25.3?5.4)cm,t'=-16.575,P
ABSTRACT
30 mm in 100 patients.The ASD was associated with atrial septal aneurysm in 2 patients.An incision 2~3 cm in length was made in the 4th intercostal space of the right parasternum to expose the right atrium,at which a purse-string suture was placed.A double-lumen delivery catheter was then punctured into the right atrium,and passed through the defect to the left atrium under the guidance of transesophageal echocardiography.An occluder made of a nickel-titanium metal alloy and 4 mm bigger than the defect was released to engage on the defect.The delivery catheter was then withdrawn.Results The operation was successfully accomplished in all the 206 patients.The operation time was 18~32 min(mean,26?7 min). No surgery-related death happened and no occluder dislodgment occurred.Mechanical ventilation was stopped at 5 hours after operation,and all the patients got out of bed on the operation day.Colour Doppler imaging 3 days after operation showed complete occlusion of the ASD without residual shunt.The length of hospitalization was 4?2 days.Follow-up examinations for 6 months in 186 patients and for 3~4.5 years in 57 patients by using Colour Doppler imaging revealed no residual shunt and normal cardiac functions.Conclusions Mini-incision transthoracic occlusion of atrial septal defect is safe and reliable in patients contraindicated to transcatheter closure.