RESUMO
@#Objective To introduce the application of transcatheter closure of multi-fenestrated atrial septal defect (ASD) via femoral vein under ultrasound guidance with amplatzer cribriform occluder (ACO) and atrial septal defect occluder (ASDO), as well as to assess its feasibility, effectiveness and safety. Methods The clinical data of 48 patients with fenestrated ASD occluded via femoral vein under ultrasound guidance from December 2015 to May 2018 in our hospital were retrospectively analyzed, including 17 males and 31 females, aged 10 months to 51 years, an average of 11.50±13.86 years, and weighting 6-79 (27.00±20.14) kg. Among 48 patients with fenestrated ASD, 12 patients had double-foramen and 13 atrial septal aneurysm combined with defects and 23 multi-foramen. All patients underwent transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) to complete the closure of fenestrated ASD. Ultrasound, electrocardiogram and chest X-ray were reviewed the next day after surgery to evaluate the curative effect. Results Forty-eight patients with ASD were treated with 49 occluders, due to one patient with two occluders. There were 29 ASDO (8-26 mm) and 20 ACO (18-34 mm). During the operation, TTE/TEE examination showed that 48 patients were completely occluded, 13 patients showed fine bundle shunt in the unreleased push notification rod, and 9 patients had fine bundle shunt after the release of push notification rod. Fine bundle shunt was found in 8 patients 24 hours after operation, and microshunt was found in 3 patients 1 year after operation. All the patients were followed up. The occluder position was good. The right heart was reduced in different degrees, and the X-ray showed that the pulmonary blood was reduced in different degrees. No arrhythmia was found by electrocardiogram after operation. Conclusion It is a safe and effective method to use ACO and ASDO to occlude ASD through femoral approach under ultrasound guidance.
RESUMO
Objective To explore the method of atrial septal defect (ASD)occlusion with occluder by minimally invasive chest ways. Methods 34 patients with ASD were anaesthetized and a 2cm～3cm-long incision was made in the 4th intercostal space of right side of sternum and a Dasdo round or elliptic occluder was placed in the heart.The ASD size and edge in various sections were measured by transesophageal echocardiography,and the type and size of occluder were accordingly selected.Two umbrellas were opened on two sides of ASD under monitoring of echocardiography.After confirming the firm of occluder and no evident atrial shunt,occluder was released,and right atrium and chest were sewed. Results 33 patients with ASD were successfully occluded and one case was failed who received extracorporeal circulation operation.The maximum diameter of ASD was 8～32(19 3?6 3)mm.The shortest edge in variant side was 0 mm to posterior wall of aortea,3.5mm to superior vena cava,6.0mm to inferior vena cava and 6.0mm to the base of mitral valve.The time for closing ASD guided by echocardiography was about 2～3 minutes. Conclusions The placement of ASD occluder through minimal incision of the chest is a new method for the treatment of ASD.It might have wider indications for ASD occlusion.