超声心动图在经胸小切口房/室间隔缺损封堵术的应用研究
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摘要
背景：超声心动图技术,含经胸超声心动图(TTE)及经食道超声心动图(TEE),具有无创、简便、测量准确、可重复进行、无放射性损伤、可实时清晰显示心脏大血管内部结构与血流动力学动态变化等优点,是临床上最常用的评估心脏结构和功能的重要诊断工具。先心病经导管封堵术已在临床得到了广泛应用,受其操作路径及造影剂的应用,仍有着一定的局限性。近年来在食道超声心动图引导下经胸小切口封堵术在临床逐步开展,并随着封堵器的不断改良,扩大了经导管封堵术的适应症,颇受患者好评。但是,由于封堵器的放置仍可能影响缺损邻近组织的结构功能,如盲目操作会引起严重并发症,所以,临床需要帮助解决的问题有：1、选择适合行封堵术的病例,严格掌握封堵手术的适应症；2、封堵器大小及型号的选择原则；3、术中监测引导和疗效评估的指标和方法等。因此,本研究的目的就是应用彩色超声多普勒技术探索建立经胸小切口封堵术前筛选病例、术中引导封堵器放置及术后疗效评估的临床标准,以保证经胸小切口封堵术的安全性和成功率。根据临床需要和彩超工作重点,研究内容分五部分。
目的探讨超声心动图(含经胸、经食道)在房间隔缺损(ASD)患儿经胸小切口封堵术中,对术前筛选病例、指导选择封堵器型号、术中监测引导封堵器放置和术后随访的临床应用价值。
方法111例ASD患儿实施了经胸小切口封堵术,术前通过经胸超声心动图(TTE)检查诊断为ASD,并多切面测量ASD大小,评价缺损残边情况,选择ASD封堵器型号的一般标准为(缺损测量最大径+4)mm；术中通过多平面经食道超声心动图(MTEE)再次评估确定封堵器型号,并引导封堵器正确放置；术后经TTE对封堵成功患儿进行定期随访评估疗效。
结果111例ASD患儿中107例成功封堵,成功率96.4%。封堵成功的超声图像为封堵器牢固嵌夹在缺损部位,过隔血流消失,邻近瓣膜及心房内血流无异常。4例封堵失败者中,3例因缺损后下缘残边短小或无残边致封堵器无法满意固定,1例多孔型ASD因封堵器放置后仍有明显残余分流而放弃封堵改体外循环下心内直视手术。部分患儿术后1周、1月、3月、6月、1年内定期随访,封堵器位置固定好,无轻度以上房室瓣反流,3例随访期间见残余分流,于术后6月内残余分流均先后消失。
结论超声心动图(含TTE、MTEE)在经胸小切口ASD封堵术对术前筛选病例、术中监测引导封堵过程、术后疗效评估有可靠、重要的作用。
目的探讨经胸小切口室间隔缺损(VSD)封堵术,超声心动图(含TTE,MTEE)对不同类型VSD的常规及特殊观测指标,并以此为依据进行术前病例筛选及指导选择封堵器型号,术中监测引导封堵器放置过程,术后判断疗效的全方位应用价值。
方法223例VSD患儿实施了经胸小切口封堵术,术前通过TTE多切面评估VSD大小、位置、类型及与周围组织的毗邻情况,选择VSD封堵器型号的一般标准为(缺损测量最大径+2)mm；术中通过MTEE再次复核评估,确定封堵器型号,并引导封堵器正确放置,同时评判封堵效果；术后经TTE对封堵成功患儿进行定期随访。
结果223例VSD患儿中206例成功封堵,成功率92.38%。不同类型VSD封堵的成功率有差别,干下型成功率最低。部分患儿术后1周、1月、3月、6月、1年内定期随访,封堵器回声清晰,位置正常,无轻量以上残余分流和瓣膜反流。
结论超声心动图(含TTE、MTEE)在经胸小切口VSD封堵术中,对术前病例筛选、术中封堵过程监测引导、术后疗效评估具有可靠、重要的作用。
目的对行超声心动图引导下经胸小切口封堵术和同期行传统外科手术治疗的ASD/VSD患儿进行超声心动图及临床指标的比较,探讨经胸小切口封堵术这一新技术的优缺点。
方法对2010年4月-2010年7月在中南大学湘雅二医院小儿心脏外科治疗的单纯左向右分流的ASD、VSD患儿,根据治疗方法将其分为封堵组(40例)和手术组(40例),对两组间治疗成功率、切口长短、超声心动图观测指标、并发症、输血量、监护时间、住院时间及费用等方面进行比较。
结果两组手术成功率均为100%,超声心动图指标提示两种治疗方法疗效相似,封堵组在输血量、监护时间、住院时间方面均少于手术组,但医疗费用高于手术组。
结论对单纯ASD/VSD,超声心动图引导下经胸小切口封堵术通过超声心动图的准确评估和引导可达到传统外科手术同样的疗效,且创伤更小,恢复更快,但费用相对较高。
目的探讨偏心型封堵器适用的VSD类型及超声心动图在经胸小切口封堵术中对偏心型封堵器选型、成功封堵的关键及操作中避免损伤的经验。
方法对55例采用偏心型封堵器成功施行经胸小切口VSD封堵术的患儿进行回顾性研究,分析适用偏心型封堵器的VSD类型、大小及形态,及通过随访评估偏心型封堵器封堵VSD的疗效。
结果成功使用偏心型封堵器的55例VSD患儿中膜周型占70.90%(膜部瘤型18%,嵴下型12.72%,余56.41%),漏斗型占29.09%(嵴内型27.27%,干下型1.81%)。封堵器型号选择一般比缺损测量最大径大2-3mm。随访示封堵器位置正确,固定满意,无轻量以上残余分流及瓣膜反流,无严重传导阻滞发生
结论偏心型封堵器的应用较好的扩大了经胸小切口封堵术的适用范围,超声心电图引导封堵器正确放置能较好保证手术的安全性和成功率。
目的分析经胸小切口封堵术的失败原因,更好的掌握适应症以提高手术成功率,为临床提供有效经验。
方法研究24例经胸小切口封堵失败患儿的缺损大小、位置、类型及缺损与周围结构的毗邻关系对手术成败的影响、分析封堵过程中操作技术及通过改传统开放手术后发现的特殊解剖因素对封堵成败的影响。
结果24例封堵失败患儿中,5例为ASD患儿,15例为VSD患儿(其中3例为干下型VSD,15例为膜周型VSD,1例为肌部VSD)。ASD失败的原因多为缺损较大、残边短小或无残边、多孔型缺损。VSD失败的原因较多,如缺损过大或过小、缺损距周围瓣膜较近,多处破口致封堵后仍有明显残余分流,缺损破口的朝向及角度,异常腱索存在及术者技术欠熟练等。
结论经胸小切口封堵术的成功施行需要经验丰富的心脏超声力量和强大的心脏外科力量默契配合,需要有规范化的超声评估与引导,严格把握适应证,熟练操作步骤和技术。
Introduction:Echocardiography,including transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), is one of the most common tools used for evaluating cardiac function and structure. It features non-invasive and simple operation, accurate and repeatable results, with no significant radioactive damage both to patients and doctors. It reveals inner cardiovascular structures and hemodynamic changes in real time and in clarity. Transcatheter closure has been widely used for treating congenital heart disease. However, due to its operating path and requirement for contrast medium, there are still some limitations. In recent years, occlusion via small chest incision under the guidance of TEE is gradually developing. With the improvement of occluders and the expanding range of indications, this technology is becoming increasingly favored by surgeons and patients. Unfortunately, it is possible that the placement of the occluder might affect the function and structure of neighboring tissues and cause severe complications. Therefore, surgeons should pay attention to these three major issues:1) suitable indications;2) the size and model of the occluder;3) strict intraoperative monitoring and efficacy assessment. Our study focused on the exploratory development of a clinical criterion in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation.for the safety and successful rate of occlusion via small chest incision.with application of color doppler imaging. The research can be described in five chapters in general.
Objective:To elucidate the clinical application value of echocardiography technology (including transthoracic echocardiography and transesophageal echocardiography) in occlusion of children's ASD via small chest incision, particularly focusing on the application of this technology in screening cases, choosing occluders, guiding and monitoring the placement of the occluder, and postoperative follow-ups as well.
Methods:We performed occlusion of ASD via small chest incision on111children. The patients were diagnosed by transthoracic echocardiography(TTE). Multiple sections were examined to quantify the ASD size and to evaluate the remaining margins. In general, the size of occluders to be selected is the maximum diameter of the defects+4mm. During operations we reassure the size of the occluders, meanwhile, guide the placement of the occluders by multiplane transesophageal echocardiography (MTEE). Patients also received postoperative follow-ups at regular intervals. MTEE were employed to assess the therapeutic efficacy.
Results:Out of the111ASD cases, defects of107patients were successfully closed, making a96.4%successful rate. Images for positive closures displayed firmly insertion of the occluders in defect regions, along with disappearance of blood flow thorough atrial spectrum while neighboring valves and blood flow inside atrium appeared to be normal. In3of the4failed cases, we failed to get the occluder in right position due to extremely short defect margins or no margin at all. The operation on the last case who was diagnosed with multiple secundum ASD was abandoned as a result of apparent remaining regurgitation after the placement of the occluder. Some patients received follow-ups at intervals of1week,1month,3months,6months and1year post-operation. The occluders stayed fixed, no severe atrioventricular valve regurgitation was observed.3cases showed occasional regurgitation which later disappeared6months post operation.
Conclusion:Echocardiography(including TTE and MTEE) gives accurate and accountable result. During occlusion of ASD via small chest incision, echocardiography technology can play vital roles in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation.
Objective:To elucidate conventional and special lab indexes detected by echocardiography (including TTE and MTEE) during occlusion of VSD via small chest incision. In addition, to discuss the potential of using these indexes in helping screen cases, choosing occluders, guiding and monitoring the placement of the occluders, and postoperative follow-ups as well.
Methods We performed occlusion of VSD via small chest incision on223children. Before operations multiple sections TTE was employed to evaluate various status including the size, position and type of the VSD region along with the condition of neighboring tissues. In general, the size of occluders to be selected is the maximum diameter of the defects+2mm. During operations we reassured the size of the occluder, meanwhile, guided the placement of the occluder by multiplane transesophageal echocardiography (MTEE). Patients also received postoperative follow-ups at regular intervals. MTEE were employed to assess the therapeutic efficacy.
Results:Out of the223VSD cases, defects of206patients were successfully closed,making a92.38%successful rate. Successful rate varied among different types of VSD, with the lowest chance of success in subarterial VSD. Some patients received follow-ups at intervals of1week,1month,3months,6months and1year post-operation. The occluders stayed firmly and echoed clearly. No notable residual shunt or valve regurgitation was discovered.
Conclusions:Echocardiography(including TTE and MTEE)gives accurate and accountable result. During occlusion of children's VSD via small chest incision, echocardiography technology can play vital roles in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation.
Objective:To compare the echocardiography and clinical results from children received occlusion of ASD/VSD via small chest incision to that received traditional surgery, and investigate the advantage and disadvantage of occlusion via small chest incision.
Methods:Children with ASD or VSD admitted to The Second Xiangya Hospital, Central South University between April2010to July,2010were divided into2groups (occlusion group and traditional surgery group,40cases each group) basing on corresponding treatments. We then compared various key performance indicators including successful rate, incision length, parameters of echocardiography, complications, quantity of blood transfusion, duration of ICU stay and hospitalization, along with hospitalization expense as well.
Results:Both groups yielded100%successful rate. Echocardiography found both treatments led to similar therapeutic efficiency. Compared to traditional surgery group, occlusion group showed decreased quantity of blood transfusion, shorter duration of ICU stay and entire hospitalization but higher expense.
Conclusion:With the precise evaluation and reliable guidance of echocardiography, occlusion via small chest incision can achieve similar therapeutic efficiency as traditional surgery, along with smaller wounds and faster recover. However, it also costs higher expenses.
Objective:To discuss indications for asymmetric occluder; and elucidate the critical role of echocardiography in choosing occluder, guiding successful occlusion and avoiding injury during operation.
Methods:Retrospective study55cases received occlusion via small chest incision using asymmetric occluder to analyze VSD type, size and morphology suitable for asymmetric occluder. Therapeutic efficiency was evaluated by follow-ups.
Results:Out of the55successful cases treated with asymmetric VSD occluder,70.90%of which were perimembranous VSD (disruption of tumor in membranous part of interventricular septum18%, subcristal VSD12.72%, others56.41%), funnel area VSD accounted for the other29.09%(intracristal VSD27.27%, subarterial1.81%)。In general, the size of occluders to be selected was the maximum diameter of the defects+2～3mm. Follow-ups showed that occluders were placed and fixed properly. No severe residual shunt, valve regurgitation or heart block was discovered.
Comclusions:Application of asymmetric occluder expands the range of indications for occlusion via small chest incision. Also, accurate echocardiography helps improving the safety and successful rate of this surgery.
Objective:To analyze the possible reasons held accountable for the failed occlusion via small chest incision; to gain better knowledge of the indications for this technology and more clinical experiences.
Methods:We examined24failed cases carefully in the factors such as the size, position and type of defects, as long as neighboring tissues and operation technique. Special anatomic malformations discovered during traditional surgery after failed occlusion were also inspected.
Results:Out of the24failed cases,5were ASD patients, the other15were diagnosed as VSD (3of them were subarterial VSD,15were perimembranous VSD, the other one was muscular VSD).Our study showed that, as for the ASD cases, besides the defect area being too large, lack of margins and multiple secundum defects also may cause the failure. The VSD cases were more complicated. Size of the defects (too large or too small), distance between the defect region and neighboring valves (too close), multiple defects, orientation and angle of the defects, abnormal chordae tendineae as well as inadequate operation techniques all might be responsible for the failure.
Conclusion:The combination of experienced echocardiography and excellent surgical technique is the decisive factor for a successful occlusion via small chest incision.
目的探讨超声心动图(含经胸、经食道)在房间隔缺损(ASD)患儿经胸小切口封堵术中,对术前筛选病例、指导选择封堵器型号、术中监测引导封堵器放置和术后随访的临床应用价值。
方法111例ASD患儿实施了经胸小切口封堵术,术前通过经胸超声心动图(TTE)检查诊断为ASD,并多切面测量ASD大小,评价缺损残边情况,选择ASD封堵器型号的一般标准为(缺损测量最大径+4)mm；术中通过多平面经食道超声心动图(MTEE)再次评估确定封堵器型号,并引导封堵器正确放置；术后经TTE对封堵成功患儿进行定期随访评估疗效。
结果111例ASD患儿中107例成功封堵,成功率96.4%。封堵成功的超声图像为封堵器牢固嵌夹在缺损部位,过隔血流消失,邻近瓣膜及心房内血流无异常。4例封堵失败者中,3例因缺损后下缘残边短小或无残边致封堵器无法满意固定,1例多孔型ASD因封堵器放置后仍有明显残余分流而放弃封堵改体外循环下心内直视手术。部分患儿术后1周、1月、3月、6月、1年内定期随访,封堵器位置固定好,无轻度以上房室瓣反流,3例随访期间见残余分流,于术后6月内残余分流均先后消失。
结论超声心动图(含TTE、MTEE)在经胸小切口ASD封堵术对术前筛选病例、术中监测引导封堵过程、术后疗效评估有可靠、重要的作用。
目的探讨经胸小切口室间隔缺损(VSD)封堵术,超声心动图(含TTE,MTEE)对不同类型VSD的常规及特殊观测指标,并以此为依据进行术前病例筛选及指导选择封堵器型号,术中监测引导封堵器放置过程,术后判断疗效的全方位应用价值。
方法223例VSD患儿实施了经胸小切口封堵术,术前通过TTE多切面评估VSD大小、位置、类型及与周围组织的毗邻情况,选择VSD封堵器型号的一般标准为(缺损测量最大径+2)mm；术中通过MTEE再次复核评估,确定封堵器型号,并引导封堵器正确放置,同时评判封堵效果；术后经TTE对封堵成功患儿进行定期随访。
结果223例VSD患儿中206例成功封堵,成功率92.38%。不同类型VSD封堵的成功率有差别,干下型成功率最低。部分患儿术后1周、1月、3月、6月、1年内定期随访,封堵器回声清晰,位置正常,无轻量以上残余分流和瓣膜反流。
结论超声心动图(含TTE、MTEE)在经胸小切口VSD封堵术中,对术前病例筛选、术中封堵过程监测引导、术后疗效评估具有可靠、重要的作用。
目的对行超声心动图引导下经胸小切口封堵术和同期行传统外科手术治疗的ASD/VSD患儿进行超声心动图及临床指标的比较,探讨经胸小切口封堵术这一新技术的优缺点。
方法对2010年4月-2010年7月在中南大学湘雅二医院小儿心脏外科治疗的单纯左向右分流的ASD、VSD患儿,根据治疗方法将其分为封堵组(40例)和手术组(40例),对两组间治疗成功率、切口长短、超声心动图观测指标、并发症、输血量、监护时间、住院时间及费用等方面进行比较。
结果两组手术成功率均为100%,超声心动图指标提示两种治疗方法疗效相似,封堵组在输血量、监护时间、住院时间方面均少于手术组,但医疗费用高于手术组。
结论对单纯ASD/VSD,超声心动图引导下经胸小切口封堵术通过超声心动图的准确评估和引导可达到传统外科手术同样的疗效,且创伤更小,恢复更快,但费用相对较高。
目的探讨偏心型封堵器适用的VSD类型及超声心动图在经胸小切口封堵术中对偏心型封堵器选型、成功封堵的关键及操作中避免损伤的经验。
方法对55例采用偏心型封堵器成功施行经胸小切口VSD封堵术的患儿进行回顾性研究,分析适用偏心型封堵器的VSD类型、大小及形态,及通过随访评估偏心型封堵器封堵VSD的疗效。
结果成功使用偏心型封堵器的55例VSD患儿中膜周型占70.90%(膜部瘤型18%,嵴下型12.72%,余56.41%),漏斗型占29.09%(嵴内型27.27%,干下型1.81%)。封堵器型号选择一般比缺损测量最大径大2-3mm。随访示封堵器位置正确,固定满意,无轻量以上残余分流及瓣膜反流,无严重传导阻滞发生
结论偏心型封堵器的应用较好的扩大了经胸小切口封堵术的适用范围,超声心电图引导封堵器正确放置能较好保证手术的安全性和成功率。
目的分析经胸小切口封堵术的失败原因,更好的掌握适应症以提高手术成功率,为临床提供有效经验。
方法研究24例经胸小切口封堵失败患儿的缺损大小、位置、类型及缺损与周围结构的毗邻关系对手术成败的影响、分析封堵过程中操作技术及通过改传统开放手术后发现的特殊解剖因素对封堵成败的影响。
结果24例封堵失败患儿中,5例为ASD患儿,15例为VSD患儿(其中3例为干下型VSD,15例为膜周型VSD,1例为肌部VSD)。ASD失败的原因多为缺损较大、残边短小或无残边、多孔型缺损。VSD失败的原因较多,如缺损过大或过小、缺损距周围瓣膜较近,多处破口致封堵后仍有明显残余分流,缺损破口的朝向及角度,异常腱索存在及术者技术欠熟练等。
结论经胸小切口封堵术的成功施行需要经验丰富的心脏超声力量和强大的心脏外科力量默契配合,需要有规范化的超声评估与引导,严格把握适应证,熟练操作步骤和技术。
Introduction:Echocardiography,including transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), is one of the most common tools used for evaluating cardiac function and structure. It features non-invasive and simple operation, accurate and repeatable results, with no significant radioactive damage both to patients and doctors. It reveals inner cardiovascular structures and hemodynamic changes in real time and in clarity. Transcatheter closure has been widely used for treating congenital heart disease. However, due to its operating path and requirement for contrast medium, there are still some limitations. In recent years, occlusion via small chest incision under the guidance of TEE is gradually developing. With the improvement of occluders and the expanding range of indications, this technology is becoming increasingly favored by surgeons and patients. Unfortunately, it is possible that the placement of the occluder might affect the function and structure of neighboring tissues and cause severe complications. Therefore, surgeons should pay attention to these three major issues:1) suitable indications;2) the size and model of the occluder;3) strict intraoperative monitoring and efficacy assessment. Our study focused on the exploratory development of a clinical criterion in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation.for the safety and successful rate of occlusion via small chest incision.with application of color doppler imaging. The research can be described in five chapters in general.
Objective:To elucidate the clinical application value of echocardiography technology (including transthoracic echocardiography and transesophageal echocardiography) in occlusion of children's ASD via small chest incision, particularly focusing on the application of this technology in screening cases, choosing occluders, guiding and monitoring the placement of the occluder, and postoperative follow-ups as well.
Methods:We performed occlusion of ASD via small chest incision on111children. The patients were diagnosed by transthoracic echocardiography(TTE). Multiple sections were examined to quantify the ASD size and to evaluate the remaining margins. In general, the size of occluders to be selected is the maximum diameter of the defects+4mm. During operations we reassure the size of the occluders, meanwhile, guide the placement of the occluders by multiplane transesophageal echocardiography (MTEE). Patients also received postoperative follow-ups at regular intervals. MTEE were employed to assess the therapeutic efficacy.
Results:Out of the111ASD cases, defects of107patients were successfully closed, making a96.4%successful rate. Images for positive closures displayed firmly insertion of the occluders in defect regions, along with disappearance of blood flow thorough atrial spectrum while neighboring valves and blood flow inside atrium appeared to be normal. In3of the4failed cases, we failed to get the occluder in right position due to extremely short defect margins or no margin at all. The operation on the last case who was diagnosed with multiple secundum ASD was abandoned as a result of apparent remaining regurgitation after the placement of the occluder. Some patients received follow-ups at intervals of1week,1month,3months,6months and1year post-operation. The occluders stayed fixed, no severe atrioventricular valve regurgitation was observed.3cases showed occasional regurgitation which later disappeared6months post operation.
Conclusion:Echocardiography(including TTE and MTEE) gives accurate and accountable result. During occlusion of ASD via small chest incision, echocardiography technology can play vital roles in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation.
Objective:To elucidate conventional and special lab indexes detected by echocardiography (including TTE and MTEE) during occlusion of VSD via small chest incision. In addition, to discuss the potential of using these indexes in helping screen cases, choosing occluders, guiding and monitoring the placement of the occluders, and postoperative follow-ups as well.
Methods We performed occlusion of VSD via small chest incision on223children. Before operations multiple sections TTE was employed to evaluate various status including the size, position and type of the VSD region along with the condition of neighboring tissues. In general, the size of occluders to be selected is the maximum diameter of the defects+2mm. During operations we reassured the size of the occluder, meanwhile, guided the placement of the occluder by multiplane transesophageal echocardiography (MTEE). Patients also received postoperative follow-ups at regular intervals. MTEE were employed to assess the therapeutic efficacy.
Results:Out of the223VSD cases, defects of206patients were successfully closed,making a92.38%successful rate. Successful rate varied among different types of VSD, with the lowest chance of success in subarterial VSD. Some patients received follow-ups at intervals of1week,1month,3months,6months and1year post-operation. The occluders stayed firmly and echoed clearly. No notable residual shunt or valve regurgitation was discovered.
Conclusions:Echocardiography(including TTE and MTEE)gives accurate and accountable result. During occlusion of children's VSD via small chest incision, echocardiography technology can play vital roles in helping screen cases preoperation, guiding occluding procedure intraoperation, and evaluating therapeutic efficacy postoperation.
Objective:To compare the echocardiography and clinical results from children received occlusion of ASD/VSD via small chest incision to that received traditional surgery, and investigate the advantage and disadvantage of occlusion via small chest incision.
Methods:Children with ASD or VSD admitted to The Second Xiangya Hospital, Central South University between April2010to July,2010were divided into2groups (occlusion group and traditional surgery group,40cases each group) basing on corresponding treatments. We then compared various key performance indicators including successful rate, incision length, parameters of echocardiography, complications, quantity of blood transfusion, duration of ICU stay and hospitalization, along with hospitalization expense as well.
Results:Both groups yielded100%successful rate. Echocardiography found both treatments led to similar therapeutic efficiency. Compared to traditional surgery group, occlusion group showed decreased quantity of blood transfusion, shorter duration of ICU stay and entire hospitalization but higher expense.
Conclusion:With the precise evaluation and reliable guidance of echocardiography, occlusion via small chest incision can achieve similar therapeutic efficiency as traditional surgery, along with smaller wounds and faster recover. However, it also costs higher expenses.
Objective:To discuss indications for asymmetric occluder; and elucidate the critical role of echocardiography in choosing occluder, guiding successful occlusion and avoiding injury during operation.
Methods:Retrospective study55cases received occlusion via small chest incision using asymmetric occluder to analyze VSD type, size and morphology suitable for asymmetric occluder. Therapeutic efficiency was evaluated by follow-ups.
Results:Out of the55successful cases treated with asymmetric VSD occluder,70.90%of which were perimembranous VSD (disruption of tumor in membranous part of interventricular septum18%, subcristal VSD12.72%, others56.41%), funnel area VSD accounted for the other29.09%(intracristal VSD27.27%, subarterial1.81%)。In general, the size of occluders to be selected was the maximum diameter of the defects+2～3mm. Follow-ups showed that occluders were placed and fixed properly. No severe residual shunt, valve regurgitation or heart block was discovered.
Comclusions:Application of asymmetric occluder expands the range of indications for occlusion via small chest incision. Also, accurate echocardiography helps improving the safety and successful rate of this surgery.
Objective:To analyze the possible reasons held accountable for the failed occlusion via small chest incision; to gain better knowledge of the indications for this technology and more clinical experiences.
Methods:We examined24failed cases carefully in the factors such as the size, position and type of defects, as long as neighboring tissues and operation technique. Special anatomic malformations discovered during traditional surgery after failed occlusion were also inspected.
Results:Out of the24failed cases,5were ASD patients, the other15were diagnosed as VSD (3of them were subarterial VSD,15were perimembranous VSD, the other one was muscular VSD).Our study showed that, as for the ASD cases, besides the defect area being too large, lack of margins and multiple secundum defects also may cause the failure. The VSD cases were more complicated. Size of the defects (too large or too small), distance between the defect region and neighboring valves (too close), multiple defects, orientation and angle of the defects, abnormal chordae tendineae as well as inadequate operation techniques all might be responsible for the failure.
Conclusion:The combination of experienced echocardiography and excellent surgical technique is the decisive factor for a successful occlusion via small chest incision.
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