|
|
|
| Efficacy of percutaneous atrial septal defect closure guided by transesophageal echocardiography in children |
XU Weize( ),YE Jingjing,LI Jianhua,ZHANG Zewei,YU Jiangen,SHI Zhuo,YU Jin,SHU Qiang*() |
| Heart Center, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China |
|
|
|
Abstract Objective: To compare the efficacy of percutaneous atrial septal defect (ASD) closure guided by transesophageal echocardiography (TEE) or guided by fluoroscopy in pediatric patients. Methods: Medical records of patients who underwent percutaneous ASD closure in the Children's Hospital, Zhejiang University School of Medicine from January 2017 to March 2018 were reviewed. There were 120 patients whose procedures were guided by TEE (TEE group), and 125 patients who had their procedures guided by fluoroscopy (fluoroscopy group). The performance of surgery, efficacy and postoperative complications were compared between two groups. Results: Percutaneous ASD closure was successful in all patients. The operation time was shorter in the TEE group than that in fluoroscopy group[(20±14) min vs. (29±11) min, t=-7.939, P < 0.05]. The size of the defect was larger in the TEE group than that of fluoroscopy group[(11±4) mm vs. (9±4) mm, t=2.512, P < 0.05], but there was no significant difference in the sizes of occluder and occluder sheath between two groups (all P>0.05). No residual shunt, occluder shedding or displacement, severe arrhythmia or pericardial effusion were observed in either group. The incidence rates of fever, cough and diarrhea were not statistically different between two groups (all P>0.05). Conclusion: There was no significant difference in the outcome of percutaneous ASD closure guided by TEE or by fluoroscopy, but the procedure guided by TEE may reduce the operation time and can evaluate the size of ASD more accurately without involving radiation exposure, contrast agents use and large digital subtraction equipment.
|
|
Received: 23 March 2018
Published: 18 September 2018
|
|
|
|
Corresponding Authors:
SHU Qiang
E-mail: 120heart@zju.edu.cn;shuqiang@zju.edu.cn
|
单纯食管超声心动图引导经皮房间隔缺损封堵术治疗房间隔缺损患儿的疗效
目的: 比较单纯食管超声心动图（TEE）引导与X射线引导经皮房间隔缺损（ASD）封堵术治疗ASD患儿的疗效差异。方法: 回顾性分析2017年1月至2018年3月浙江大学医学院附属儿童医院行单纯TEE引导经皮ASD封堵术患儿（TEE组，120例）和行X射线引导经皮ASD封堵术患儿（X射线组，125例）的资料。比较两组的手术实施情况、术后疗效和术后并发症发生情况等资料。结果: TEE组和X射线组均顺利完成ASD封堵术。TEE组手术时间为（20±14）min，X射线组为（29±11）min，差异有统计学意义（t=-7.939，P < 0.05）；TEE组ASD直径为（11±4）mm，大于X射线组[（9±4）mm，t=2.512，P < 0.05]，但两组在术中使用的封堵器直径和外鞘直径差异无统计学意义（均P>0.05）。两组患儿术后均无残余分流、封堵器脱落或移位，未发生严重心律失常、心包积液。术后发热、咳嗽、腹泻的发生率两组间差异无统计学意义（均P>0.05）。结论: 单纯TEE引导经皮ASD封堵术与X射线引导经皮ASD封堵术疗效相近，但前者避免了射线辐射、手术时间短、对ASD的直径评估更精确，且无需使用大型数字减影设备，适宜推广和普及。
关键词：
房间隔缺损/外科学,
房间隔缺损/超声检查,
超声心动描记术, 经食管,
X线透视检查,
儿童,
治疗结果
|
|
| [1] |
DU Z D , HIJAZI Z M , KLEINMAN C S et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults:results of a multicenter nonrandomized trial[J]. J Am Coll Cardiol, 2002, 39 (11): 1836- 1844
doi: 10.1016/S0735-1097(02)01862-4
|
|
|
| [2] |
MOORE J , HEGDE S , EL-SAID H et al. Transcatheter device closure of atrial septal defects:a safety review[J]. JACC Cardiovasc Interv, 2013, 6 (5): 433- 442
doi: 10.1016/j.jcin.2013.02.005
|
|
|
| [3] |
KLEINERMAN R A . Cancer risks following diagnostic and therapeutic radiation exposure in children[J]. Pediatr Radiol, 2006, 36 (Suppl 2): 121- 125
|
|
|
| [4] |
National Research Council(US) Board on Radiation Effects Research. Health risks from exposure to low levels of ionizing radiation: BEIR Ⅶ Phase 2[C]. Washington, D.C.: National Academies Press, 2006.
|
|
|
| [5] |
WAGDI P , RITTER M . Patient radiation dose during percutaneous interventional closure of interatrial communications[J]. J Cardiol, 2009, 53 (3): 368- 373
doi: 10.1016/j.jjcc.2009.01.001
|
|
|
| [6] |
YAKOUMAKIS E N , GIALOUSIS G I , PAPADOPOULOU D et al. Estimation of children's radiation dose from cardiac catheterisations, performed for the diagnosis or the treatment of a congenital heart disease using TLD dosimetry and Monte Carlo simulation[J]. J Radiol Prot, 2009, 29 (2): 251- 261
doi: 10.1088/0952-4746/29/2/011
|
|
|
| [7] |
KARDON R E , SOKOLOSKI M C , LEVI D S et al. Transthoracic echocardiographic guidance of transcatheter atrial septal defect closure[J]. Am J Cardiol, 2004, 94 (2): 256- 260
doi: 10.1016/j.amjcard.2004.03.080
|
|
|
| [8] |
HONGXIN L , ZHANG N , WENBIN G et al. Peratrial device closure of perimembranous ventricular septal defects through a right parasternal approach[J]. Ann Thorac Surg, 2014, 98 (2): 668- 674
doi: 10.1016/j.athoracsur.2014.03.029
|
|
|
| [9] |
卢衡, 陈良万, 张贵灿 et al. 超声心动图引导下经皮房间隔缺损封堵术的临床评估[J]. 中南大学学报:医学版, 2015, 40 (6): 646- 650
LU Heng , CHEN Liangwan , ZHANG Guican et al. Clinical evaluation of percutaneous atrial septal defect closer guided by transthoracic echocardiography and/or transesophageal echocardiography[J]. Journal of Central South University:Medical Sciences, 2015, 40 (6): 646- 650
|
|
|
| [10] |
潘湘斌, 逄坤静, 胡盛寿 et al. 经食管超声心动图引导下介入治疗房间隔缺损幼儿的有效性和安全性[J]. 中华心血管病杂志, 2013, 41 (9): 744- 746
PAN Xiangbin , PANG Kunjing , HU Shengshou et al. Safety and efficacy of percutaneous transcatheter closure of atrial septal defect under transesophageal echocardiography guidance in children[J]. Chinese Journal of Cardiology, 2013, 41 (9): 744- 746
doi: 10.3760/cma.j.issn.0253-3758.2013.09.005
|
|
|
| [11] |
EWERT P , BERGER F , DAEHNERT I et al. Transcatheter closure of atrial septal defects without fluoroscopy:feasibility of a new method[J]. Circulation, 2000, 101 (8): 847- 849
doi: 10.1161/01.CIR.101.8.847
|
|
|
| [12] |
BARUTEAU A E , HASCO?T S , FRAISSE A . Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children[J]. J Thorac Dis, 2017, 9 (5): 1247- 1256
doi: 10.21037/jtd
|
|
|
|
Viewed |
|
|
|
Full text
|
|
|
|
|
Abstract
|
|
|
|
|
Cited |
|
|
|
|
| |
Shared |
|
|
|
|
| |
Discussed |
|
|
|
|
