Clinical study of transcatheter closure of atrial septal defect in children guided by echocardiography / 中华实用儿科临床杂志

ABSTRACT

Objective:To study the method and clinical effect of transcatheter closure of children′s secondary atrial septal defect (ASD) by femoral vein under the guidance of echocardiography.Methods:A total of 306 children (137 males and 169 females) with secondary ASD undergoing transcatheter closure surgery in the Department of Car-diology of Beijing Children′s Hospital from January 2017 to October 2019 were enrolled.The age of the patients was 2.1-15.0 years old [(6.18±2.45) years old], and the weight was 10-63 kg [(23.05±9.97) kg]. Among 306 children, 259 cases had single central ASD, with the defect diameter of 5-25 mm; 47 cases had ethmoid ASD, and the shunting range was measured to be 11-31 mm by echocardiography.Patients had normal cardiac function, and no other cardiac malformations were found.Eighteen children are complicated with other system malformations, including funnel chest in 5 children, chicken chest in 4 children, scoliosis in 4 children, epilepsy in 2 children, and Down′s syndrome in 3 children.In addition, there were 8 children with ASD and arrhythmia.Specifically, 3 cases were complicated by preexcitation syndrome, 3 cases by ventricular premature beat and 2 cases by supraventricular tachycardia.Three patients with ventricular premature beat, 1 patient with supraventricular tachycardia and 1 patient with preexcitation syndrome had indications of radiofrequency ablation.All the operations were performed in the same time with ASD occlusion via femoral vein under basic anesthesia.ASD occlusion was guided by transthoracic or transesophageal echocardiography.Results:Of all 306 cases enrolled, ASD occlusion was successfully performed in 301 cases under the guidance of echocardiography, but it failed in 5 cases due to the large ultrasonic defect during the operation.For these 5 patients, the occluder was successfully released by the method of left superior pulmonary vein under X-ray.The operation time (from the beginning of anesthesia to the sheath extubation) was 17-45 min, with an average of (21.25±8.84) min.The occluder model was 10-30 mm.The operation process was smooth, and there were no serious complications during and after the operation.Conclusions:ASD transcatheter closure by femoral vein puncture under the guidance of echocardiography is safe and feasible operation for children with ASD.It is minimally invasive and causes no radiation injury.