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Clinical data of 23 children with atrial septal defect and pulmonary valvular stenosis admitted in Dalian Children′s Hospital during March 2015 to March 2018 were retrospectively analyzed. Twenty patients were treated with percutaneous closure of atrial septal defect through femoral vein first, then transthoracic echocardiography-guided balloon pulmonary valvuloplasty was performed; while 3 patients had no balloon pulmonary valvuloplasty after percutaneous closure of atrial septal defect. Patients were followed up by transthoracic echocardiography and all were doing well. The transvalvular pressure fell under 35 mmHg (1 mmHg=0.133 kPa) [(19.5±1.9)mmHg] in all patients, which was significantly lower than that before treatment [(62.0±7.8 mmHg)] (t=28.92, P<0.01). During follow-up, no residual shunt of atrial septal defect was found; and mild pulmonary regurgitation occurred in 3 cases. The study indicates that combined percutaneous treatment with transthoracic echocardiography guidance is effective and safe for children with atrial septal defect and pulmonary valvular stenosis. The pulmonary artery stenosis of some patients can be alleviated, after closuring of the atrial septal defect.
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Objective To investigate the value of three-dimensional speckle tracking imaging (3D-STI) in quantitative evaluation of left ventricular global strain in patients with atrial septal defect (ASD) before and after transcatheter closure.Methods Totally 35 patients with secondary ASD who received successful transcatheter occlusion were selected.Routine echocardiography and 3D-STI examination were performed before the operation,2 days,1 month,3 months and 6 months after the operation.Routine echocardiography was used to obtain the parameters of left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVEDS),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),stroke volume (SV) and other parameters.The left ventricular global peak longitudinal strain (GPLS),left ventricular global peak circumferential strain (GPCS),left ventricular global peak radial strain (GPRS) and left ventricular global peak area strain (GPAS) were examined with 3D-STI.The preoperative and postoperative parameters at each time point were analyzed statistically.Results Routine echocardiography showed that LVEDD,LVEDS,LVEDV,LVESV and SV increased significantly after operation,but no significant difference was found to compare each other 2 days,1 month,3 months and 6 months after operation (all P＞0.05).3D-STI examination showed that left ventricular GPLS,GPCS,GPRS and GPAS increased after operation,and the most increase was noticed at the second day after transcatheter occlusion.GPLS,GPCS and GPAS 6 months after operation were larger than those 3 months after operation (all P＞0.05).Conclusion 3D-STI technique can evaluate the left ventricular global strain in patients with ASD before and after occlusion.Compared with conventional echocardiography,3D-STI technique can objectively and effectively evaluate the changes of left ventricular systolic function.
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Objective To evaluate the accuracy of three-dimensional printing atrial septal defect (ASD)models from three dimensional transesophageal echocardiography(3D-TEE)images and to lay the foundation for the application of 3D printing technology in the diagnosis and treatment of ASD.Methods Twenty patients with ASD were analyzed retrospectively.2D-TEE and 3D-TEE were performed before ASD occlusion.The 3D-TEE data were post-processed by Mimics software and the volume images of ASD in STL format were developed.Then the STL file was output and the ASD 3D models were printed.The ASD size parameters included the maximal diameter(Dmax),the minimal diameter(Dmin),circumference(C)and area(A),which were measured from 2D-TEE images,3D-TEE images and 3D printing models,respectively. The absolute difference value of ASD size parameters between 3D printing models and 2D-TEE images,or 3D-TEE images were calculated.The sizes of occluder were recorded during the operation and the preoperative exercises on 3D printing models were performed.Results There were no significant difference in ASD size parameters among 3D printing models,2D-TEE and 3D-TEE images(all P > 0.05),the ASD size parameters were concordant well between 3D printing models and 2D-TEE or 3D-TEE images. Moreover,the absolute difference value of ASD size parameters between 3D printing models and 2D-TEE or 3D-TEE images were little.In addition,linear regression analysis revealed a significant correlation in the Dmaxmeasured from 3D printing models and the sizes of occulder used in the operation(r =0.94,P <0.05).In the ASD 3D printing models the preoperative exercise had an impressive effect.Conclusions It is quite feasible to use 3D-TEE images as the data source of ASD 3D printing models.Ultrasound-derived ASD 3D printing models are of highly accuracy,which have the potential to provide evidence for the clinical application of 3D printing technology.
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Objective To compare the clinical effects of totally thoracoscopic surgery and conventional median thoracoto my surgery in the repair of atrial septal defect(ASD),so as to provide reference for the clinical choice of atrial septal defect repair.Methods 131 patients with ASD from January 2015 to November 2016 in the First Affiliated Hospital of Xinjiang Medical University were divided into two groups according to operation type:totally thoracoscopic group(58 cases),median thoracotomy group.The differences in operative time,cardiopulmonary bypass time(CPB),ventilator assist time,ICU stay time,postoperative hospital stay and other aspects were compared.Results There was no death and no serious complication in the two groups.There was no statistical difference between the two groups (P ＞ 0.05) in sex,weight,age,right atrial size and cardiac function.The time of thoracoscopic surgery [(3.6 ± 1.0) h vs.(2.6 ± 0.6) h] and the duration of CPB [(98.3 ± 35.8)min vs.(32.3 ± 16.1) min] were longer than those of median thoracotomy group (P ＜ 0.05).There was no statistical difference between two groups in the time of mechanical ventilation,ICU stay,postoperative drainage and postoperative hospital stay (P ＞ 0.05).Conclusion Although ASD repair of thoracoscopic surgery is difficult and the learning curve is long,but it can be said that the totally thoracoscopic ASD repair can achieve the same results as conventional median thoracotomy does,and it is effective and safe,and thoracoscopic surgery also has less trauma and cosmetic appearance,no bone structure damage,worthy of clinical promotion.
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Objective To evaluate right ventricular (RV) global and regional volume and systolic function in patients with secondum atrial septal defect (ASD) using real-time three-dimensional echocardiography (RT3DE),and to explore the relationship between parameters derived from RT3DE and parameters measured by conventional echocardiography.Methods RT3DE images were acquired from 22 patients with secundum ASD and 22 normal controls for evaluation and analysis to obtain RV global and regional end-diastolic volume (EDV),end systolic volume (ESV),systolic volume (SV) and ejection fraction (EF) in three compartments (inflow,body and outflow).RV dyssynehrony parameters were calculated as the standard deviation (SD) and maximum difference (dif) of time to minimum systolic volume (Tmsv) and Tmsv corrected by heart rate (Tmsv％) in three RV compartments.Conventional echocardiographic parameters including pulmonary artery systolic pressure (PASP),pulmonary vascular resistance (PVRe) and maximum diameter of ASD (ASD-D) were calculated and recorded.Results RV global and regional EDV,ESV and SV were larger (all P ＜0.001) and EF was lower (all P ＜0.05) in the ASD group than in the controls.RV regional volume and systolic function were changed to various degrees in different compartment in the patients group.There were no significant differences in Tmsv,Tmsv％ and RV dyssynchrony parameters between the two groups.In patients with ASD,RV global and regional EDV,ESV and SV in the inflow compartment were positively correlated with ASD-D and PASP (r =0.463-0.704,all P ＜ 0.05) ; RV global EF was negatively correlated with PVRe (r =-0.477,P ＜ 0.05).Conclusions In patients with ASD,RV global and regional volume was enlarged and systolic function was impaired with distinct characteristics; RV global volume and regional volume in the inflow compartment were positively correlated with RV pre-load while RV global EF was negatively correlated with RV afterload.
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Objective To study the relationship of the antepartum foramen ovale (FO),the ratios of foramen ovale and aorta (FO/AO) and postpartum ostium secundum atrial septal defect (ASD).Methods Nine hundred fifty-eight fetuses were divided into 5 groups by gestational age,18-22 weeks,23-26 weeks,27-30 weeks,31-34 weeks,35-40 weeks.The diameter of FO and aortic (AO) and FO/AO were measured by fetal echocardiography,the postpartum echocardiography were followed up more than 12 months after birth.ANOVA was used to compare FO,AO,FO/AO with different gestational age.Regression equation estimate was used to compare the relationship of FO and AO with gestational age.Independent sample T test was used to compare FO and FO/AO with postpartum ostium secundum ASD and postpartum normal heart.Results There was significant difference in FO and AO among 5 groups(P =0.000),FO and AO increased with increasing gestational age.There was significant difference in antepartum FO,FO/AO between postpartum ostium secundum ASD and postpartum normal heart (P =0.000).Conclusions Antepartum FO and FO/AO provide clinical value in observing postpartum ostium secundum ASD.
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Objective To explore the advantage of mild hypothermia and beating heart bypass in patch therapy for atrial septal defect. Methods 92 patients with atrial septal defect were carried out surgical repairing by mild hypothermia and beating heart bypass. Results There was no death. There was 1 case complicated by cerebral air embolism;The consciousness recovered after 3 days of operation. There were 2 cases of pneumonia. Conclusion The patch therapy of mild hypothermia and beating heart bypass for atrial septal defect had small influence on internal environmental,fewer complications,and could be easy to carry out,and could be the first choice.
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Objective To determine whether real-time three-dimensional transesophageal echocardiography(RT-3D TEE) is an accurate non-invasive technique for defining the morphology of atrial septal defects(ASD). Methods In 20 patients with secundum ASD, mean age 42.2 years (7 male, 13 female) ,live three dimensional surgical views of ASD were acquired,qualitative morphology of ASD such as the shape, presence of fenestrations and the defect margins were noted during the cardiac cycle. The measurements obtained from 2-dimensional transesophageal echocardiography(2D-TEE) and RT-3D TEE were compared to those obtained from stretched balloon diameter(SBD) or surgery. Measurements of the size and area change of ASD were validated during the cardiac cycle by RT-3D TEE,stepwise multiple linear regression analysis was performed to test the correlation between the maximum change ratios of area and diameter of ASD and age, atrial septal length, ASD shunting velocity, the maximum diameter of ASD and right ventricular systolic pressure. Results ① The morphology of ASD was circle-like or elliptical in systole,irregular or elliptical in diastole. ②The area and diameter of ASD measured by RT-3D TEE was minimal in isovolumetric contraction phase, maximal in isovolumetric diastole phase. The correlation coefficient of maximum diameter measured by 3D with SBD was 0.962 , greater than that by 2D and SBD (0.820). ③The change ratio of area and maximum diameter of ASD acquired by RT-3D-TEE was 11.48%-71.12% and 2.80%-43.87% respectively,and the correlation coefficient of them was 0.921. Conclusions RT-3D TEE using live 3D-Zoom mode accurately displayed the varying morphology,dimensions and spatial relations of ASD. RT-3D TEE can offer visualization morphological changing of ASD in different periods of cardiac cycle,providing more information for percutanous catheter intervention and open heart surgery.
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We have experienced five cases of atrial septal defect closure under complete port access using the da Vinci system. We used only six 8~12 mm ports without thoracotomy or sternotomy for operation.
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Heart Septal Defects, Atrial , Robotics , Sternotomy , ThoracotomyABSTRACT
Objective To evaluate the application valve of intraoperative device closure secundum atrial sepetal defect (ASD) associated with deficient rims inducted by transoesophageal echocardiography (TEE). Methods Twenty-three patients with ASD were diagnosed by transthoracic echocardiography (TTE) ,and underwent an attempted intraoperative device closure through a right antierior minithoraetomy. The positon, type and size and rim of ASD were defined by TEE in preoperation, the placement of the device inducted and evaluated by TEE intraoperation,and followed by TTE after one week. Results Twenty-three patients with ASD were closed excellently. There were not shunt of atrial level in 20 patients, trivial shunt in 3 patients. However,follow-up after one week TTE indicated that all patients had no shunt,and the diameter of right atrium and right ventricle was decrease significantly (P <0.05), and pulmonary artery pressure was less than before (P <0.05). Conclusions It is very important that TEE induct the closure of ASD associated with deficient rims in micro-operative room.
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Objective To investigate the effect of right ventricular(RV)volume and RV pressure overload on left ventricular(LV)rotation and twist in patients with atrial septal defecl(ASD).Methods Using speckle tracking imaging(STI),the peak rotation of 6 segments in basal and apical short-axises was measured respectively in 35 patients with ASD(18 of which with pulmonary hypertension)and 21 healthy subjects as controls.The average peak rotation and duration time of the 6 segments in basal and apical short-axises in negative direction during early systolic phase were also measured respectively.LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated.LV ejection fraction(EF)was measured by biplane Simpson method.Results Compared to ASD patients without pulmonary hypertension and healthy subjects,the peak rotation of posterior wall,inferior wall and postsept wall in basal was lower(P＜0.05).And at the basal level,the averagepeak rotation of 6 segments in negative direction during early systolic phase was higher(P＜0.05),and the average duration time was delayed(P＜0.05).LV peak twist was also lower(P＜0.05),and had a significant negative correlation with pulmonary arterial systolic pressure(r=-0.57,P=0.001).There were no significant differences in LVEF among 3 groups.Conclusions Although RV volume overload due to ASD has no significant effects on LV rotation and twist,LV peak twist is lower in ASD patients with pulmonary hypertension.Thus LV twist may be a new index which predicting whether ASD patients also has pulmonary hypertension or not.
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Objective To evaluate the feasibility and effect of transthoracic echocardiography(TTE)on guiding the occlusion of the soft-rim atrial septal defect(ASD).Methods Sixty two patients with the soft-rim ASD were enrolled.The size of ASD was measured and rim of ASD was observed by TTE on various views by using color Doppler system with tissue harmonic function before occlusion,and filmy rim of ASD with flapping which could not sustain occluder was eliminated.The size of occluder was selected by integratively judging the size of ASD and"sustainable diameter of ASD"The waist size of occluder was measured after releasing occluder and compared with the longest diameter of ASD and"sustainable diameter of ASD"measured by TTE.Results The longest diameter of ASD measured by TTE before occlusion was 11-35 mm[average(21.6±5.2)mm],the "sustainable diameter of ASD"was 15-37 mm[average(25.6±5.(J)mm],the size of selected occluder was 18-44mm[average(30.7±5.5)mini and the waist size of released occluder was 13-35 mm[average(24.2±5.6)mm].Fine correlation was existed between the longest diameter of ASD measured by TTE and the waist size of released occluder(r=0.86,P＜0.000I).Morever,improved correlation was found between the"sustainable diameter of ASD"measured by TTE and the waist size of released occluder(r=0.89,P＜0.0001).Occluder was firmly fixed without falling in all patients.Conclusions TTE with tissue harmonic function can be used to measure the size of soft-rim ASD and the"sustainable diameter of ASD".It is a feasible,and effective method on guiding occlusion of soft-rim ASD.
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Objective To evaluate the clinical value of transesophageal echocardiography (TEE) on minimally invasive surgical closure of heart septal defects. Methods Thirty-four patients with atrial septal defect (ASD) and 38 patients with ventricular septal defect(VSD) were selected by transthoracic echocardiography (TTE) prepared for minimally invasive surgical closure. TEE was performed to choose appropriate occluder and guide occluder release during the procedure. The immediate closure effect also evaluated by using TEE. A week follow-up was done by using TTE. Results Successful occlusion was in 32 patients with ASD and 29 patients with VSD. On 1 week follow-up,neither displacement for the occluders nor residual shunt except minimal residual shunt in 3 patients. The ventrieular remodeling was improved, the valvular regurgitation and pulmonary arterial pressure decreased. Conclusions TEE is important in minimally invasive surgical closure of atrial, ventricular septal defects, especially in choosing the candidate for the procedure and occluder, guiding occluder released and evaluating the procedure.
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BACKGROUND: Minimally invasive surgery is currently popular, but this has been applied very sparingly to cardiac surgery because of some limitations. Our study evaluated the safety and efficacy of atrial septal defect (ASD) closure through a video-assisted mini-thoracotomy. MATERIAL AND METHOD: Fifteen patients were analyzed. Their mean age was 31+/-6 years. The mean ASD size was 24+/-5 mm and there were 3 cases of significant tricuspid regurgitation. The working window was made through the right 4th intercostal space via a 4~5 cm inframammary skin incision. CPB was conducted with performing peripheral cannulation. After cardioplegic arrest, the ASDs were closed with a patch (n=11) or direct sutures (n=4), and the procedures were assisted by using a thoracoscope. There were 3 cases of tricuspid repair and 1 case of mitral valve repair. The mean CPB time and aortic occlusion time were 160+/-47 and 70+/-26 minutes, respectively. RESULT: There was no mortality, but there were 3 minor complications (one pneumothorax, one wound dehiscence and one arrhythmia). The mean hospital stay was 5.9+/-1.8 days. The mean follow-up duration was 10.7+/-6.4 months. The follow-up echocardiogram noted no residual ASD or significant tricuspid regurgitation. Three patients suffered from pain or numbness. CONCLUSION: This study showed satisfactory clinical and cosmetic results. Although the operative time is still too long, more experience and specialized equipment would make this technique a good option for treating ASD.
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Humans , Catheterization , Cosmetics , Follow-Up Studies , Heart Septal Defects, Atrial , Hypesthesia , Length of Stay , Mitral Valve , Operative Time , Pneumothorax , Skin , Sutures , Thoracic Surgery , Thoracoscopes , Thoracoscopy , Tricuspid Valve InsufficiencyABSTRACT
Percutaneous transcatheter closure of atrial septal defects as a therapeutic alternative in appropriate patients provides superior cosmetic results, is less invasive, and allows for shorter hospital stays. Unfortunately, however, such percutaneous procedures can be associated with catastrophic procedure complications that may require immediate surgical intervention. We report a case of aorta-to-right atrial fistula two months after transcatheter occlusion of an atrial septal defect by an Amplatzer septal occluder. Revealed by dyspnea, palpitation and hemolysis, this complication needed an emergency surgical operation. The fistula between the noncoronary Valsalva sinus of the aorta and the right atrium was repaired. The atrial septal defect was closed by patch. The cause of this serious complication appears to be erosion into the aorta by the right atrial disk.
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Humans , Aorta , Dyspnea , Emergencies , Fistula , Heart Atria , Heart Septal Defects, Atrial , Hemolysis , Length of Stay , Prostheses and Implants , Septal Occluder Device , Sinus of ValsalvaABSTRACT
Objective: The aim of this study is to compare the clinical data and result between transcatheter closure and surgical repair for the treatments of secundum ASD in patients above 50 years old, and explore the indications for these two methods. Methods: From January 1998 to December 2003, 53 patients with surgical repair and 42 patients with transcatheter closure were enlisted according to the diagnosis of ASD. The ages of all of cases were above 50 years old. The interventional approach was administrated with Amplatzer device. The surgical approach mended the defect directly or with autologous pericardium. These patients were followed up by echocardiography (Echo). The clinical data including the diameter of the right ventricle (RVD), the pulmonic flow velocity, the pulmonary pressure and the tricuspid valve regurgitation. Results: In surgery group, surgical mortality was 1 9% (1/53). Cerebral embolism occurred in 4 (7 5%) patients. Pericardial effusion and other complications occurred in 24.5%. All 42 patients with ASD were effectively closed with Amplatzer occlude. One occluder displaced and moved into pulmonary artery on the fourth day after the treatment. The short term effective rate was 97 6% in transcatheter closure group. The diameter of ASD showed by Echo was significantly less in patients treated with transcatheter closure than that in surgical repair group. The hospitalization time was significantly less in patients treated with transcatheter closure. The follow up data recorded decreased load of right ventricle, the decreased diameter of right ventricle as well as the relief of pulmonary artery hypertension. Conclusion: The data suggested that of surgical approach of ASD has a wider indication for patients in different stages of the disease, whereas surgical morbidity may increase in elderly patients due to their pre existed diseases. However, the transcatheter closure for ASD is feasible for patients with smaller defects.
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Objective To evaluate changes of RV volume and function in patients with ASD after transcatheter closure of ASD by three-dimensional echocardiography. Methods In 58 patients with ASD (24 men, 34 women; mean age 28.9?17.1, range 4 to 67 years), 23 patients (11 men, 12 women; mean age 25.7?13.3, range 6 to 57 years) were diagnosed as secundum ASD [the stretched diameters of ASD were from 9 to 36 (25.1?7.5) mm], and had successfully received Amplatzer septal occluder (ASO, the sizes of ASO ranged from 11 to 40 mm ). 32 healthy people (18 men, 14 women; mean age 24.8?12.0, range 4 to 45) were matched interms of age and sex as the control group. Three-dimensional images were acquired by HP-SONOS 5500 cardiac scanner (Hewlett-Packard Company, Andover, Mass) and were reconstructed by Tom-Tec EchoView 4.2 (TomTec Imaging Systems, GmbH) to calculate right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV) and right ventricular ejection fraction (RVEF). RVEDV, RVESV and RVEF were measured at 3 days, 1 and 3 months after the procedure. Results The RVEDV and RVESV [(101.74?25.17) mL vs (59.65?15.00) mL, P
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Moyamoya disease is an unusual cerebrovascular disorder characterized by occlusive intimal dysplasia of the distal internal carotid and proximal cerebral arteries, but the etiology remains unclear. Angiographic characteristics include bilateral stenosis or occlusion of the terminal portions of the intracranial internal carotid arteries and bilateral development of fine collateral vessels at the base of the brain known as 'Moyamoya vessels'. Cardiac surgery using cardiopulmonary bypass due to coronary artery disease and others among patients with moyamoya disease is very rare, and cardiac surgery for such patients has a potential risk of intraoperative and perioperative brain ischemia. We successfully treated a patient who underwent artrial septal defect closure and coronary artery bypass graft using the cardiopulmonary bypass, so we report this case with a brief literature review.
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Humans , Brain , Brain Ischemia , Cardiopulmonary Bypass , Carotid Artery, Internal , Cerebral Arteries , Cerebrovascular Disorders , Constriction, Pathologic , Coronary Artery Bypass , Coronary Artery Disease , Moyamoya Disease , Thoracic Surgery , TransplantsABSTRACT
Objective To evaluate the clinical effectiveness of interventional treatment of atrial septal defect (ASD). Methods Transcatheter closure of ASD was performed in 480 cases (198 males and 282 females), age ranged from 1.2 to 72 years (mean 24?8 years). All patients finished clinical examination, chest X-ray, electrocardiography (ECG) and trans-thoracic echocardiography (TTE) for the diagnosis of secundum ASD. The stretch diameter of ASD varied from 6-34 mm, mean 16?4 mm. Four hundred and seventy cases were simple opening secundum ASD. Results The devices were discharged successfully in all patients. The diameter of the occluders selected ranged from 10-40 mm, mean 20?6 mm. Among the patients who had multiple-openings, six cases were closed completely with one occluder, and the other four cases were closed with two occluders. Conclusion Interventional treatment is an effective, safe and optimal choice for the treatment of ASD.
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We present a case of coronary artery fistula originating from the proximal left anterior descending artery draining into the main pulmonary artery,which was associated with atrial septal defect.The patient was a 56 year old male who was admitted for exertional dyspnea and abdominal distension.Echocardiogram and selective coronary arteriogram revealed a atrial septal defect and fistulous connection.The patient underwent surgery under the cardiopulmonary bypass with fibrillating heart.The pericardial patch closure of atrial septal defect and internal obliteration of the fistula termination site in the main pulmonary artery were performed.Postoperative hospital courses were uneventful without any specific complication and the patient was discharged without problem.