多发性房间隔缺损介入治疗

目的本文报告1998年10月-2006年11月13例多发性ASD介入治疗体会。方法13例中男3例,女10例。年龄4~60岁,平均(26.1±4.2)岁。13例中9例2处缺损,3例3处缺损,1例4处缺损。合并房间隔膨出瘤2例,1例合并心房纤颤和心包积液。结果13例中11例应用一个闭合器功闭合,闭合器型号12~40 mm,2例应用两个闭合器闭合缺损,型号均为18/8 mm,2例术后残余分流。无其它并发症。结论多发性ASD介入治疗,必用TEE监测,确定ASD数目、直径和间距,尽量用1个闭合器闭合多处缺损。     

Right atrial myxoma developing 4 years following patch closure of an atrial septal defect: Report of a case

We report herein the rare case of a 13-year-old boy in whom a right atrial myxoma developed 4 years following patch closure of an ostium secundum atrial septal defect, at which time no other atrial abnormality had been observed. The myxoma arose from the atrial septum in the area between the orifices of the coronary sinus and inferior vena cava. The suture line was not involved. Gross and histopathological findings were characteristic of atrial myxoma. Atrial myxomas are usually considered to be slow-growing neoplasms; however, this case demonstrates that the initial period of growth may be quite rapid in some cases.     

Impaired ventilatory efficiency after closure of atrial or ventricular septal defect

Objectives: Atrial and ventricular septal defects are the most common congenital heart defects and the closing procedures share important similarities. Generally, the postoperative outcome is considered benign, but there is growing concern regarding late ventilatory function. Therefore, the aim of this review was to describe the ventilatory function in patients with open as well as percutaneously or surgically closed atrial and ventricular septal defects. Methods: We performed a search protocol based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A data collection form was specifically developed and data were extracted from the included studies by a primary reviewer and cross-checked by the secondary reviewer. Results: We found an increasing evidence of late impairment in ventilatory efficiency, and despite that ventilatory function is commonly normal at rest, abnormalities were disclosed during exercise. There are indices that surgical closure plays an important role. Discussion: Atrial septal defect and ventricular septal defect patients have persisting, long-term impairment in ventilatory efficiency during exercise. Although the pathogenesis behind this finding may be multifactorial, there are indices that the surgical procedure may play an important role. Nevertheless, the literature is this field is sparse, and additional studies are needed.     

Deterioration of ebstein disease after closure of atrial septal defect

We treated a 7-year-old girl in whom the clinical evidence of Ebstein disease was manifest after a surgical closure of an atrial septal defect. This manifestation, which was not evident either in the preoperative catheterization studies or during operative investigation of closure of the atrial septal defect, required further hemodynamic and angiographic evaluation. Tricuspid valve replacement with Hall-Kaster prostheses was carried out.     

Permanent chronotropic impairment after closure of atrial or ventricular septal defect

Objectives. Atrial and ventricular septal defects are commonly closed surgically with low rates of post-operative morbidity, and the long-term outcome has widely been described as benign. Nevertheless, there is an increasing understanding of late morbidity, and the possibility of postoperative chronotropic impairment is continuously questioned. Furthermore, potentially abnormal chronotropic responses may be associated with the recently demonstrated overrepresentation of late arrhythmias. We conducted this review to methodically describe the potential effects of surgical defect closure on the chronotropic response to exercise. Methods. We performed a search protocol based on the 'Preferred Reporting Items for Systematic Reviews and Meta- Analyses' (PRISMA) guidelines. A data collection form was specifically developed and data were extracted from the included studies by a primary reviewer and crosschecked by a secondary reviewer. Results. A search of electronic databases revealed 16 publications, which consistently reported an abnormal heart rate responses to exercise after surgical closure. In contrast, these and other studies convincingly showed normal chronotropic response in un-operated patients as well as after percutaneous closure. Potential mechanisms include disturbances in the sinoatrial or atrioventricular conduction system and denervation in the proximity of the aorta during the surgical procedure. Discussion. ASD and VSD patients have abnormal heart rate responses to exercise after surgical closure, which indicates a need of change in the preoperative information given to these patients and their parents before surgical defect closure. Although there may not be any alternatives to surgery, patients should still be informed about potential long-term consequences, including the risk of chronotropic incompetence. Moreover, this review suggests that ‘specialized’, long-term follow up may be indicated.     

Atrial septal defect closure in young females by an anterolateral thoracotomy

There are many approaches for closure of atrial septal defects. We used an anterolateral thoracotomy for closure of atrial septal defects in 140 young females for cosmetic considerations. The technique was relatively simple and no extra equipment was needed. The outcome was excellent however breast development will need to be followed up as many of these were pre pubertal children.     

Results of surgical closure of isolated secundum atrial septal defect

Methods A retrospective analysis of all patients undergoing surgical closure of an isolated secundum atrial septal defect, at the Postgraduate Institute, Chandigarh between January 1974 and June 2000 was performed. 740 patients were divided into two groups. Group I. Included 435 patients under 20 yrs of age (223 male), 315 (72%) were asymptomatic, 265(61%) were in sinus rhythm. Group II. included 305 patients between 21 and 53 years (96 males), 27 patients (9%) were asymptomatic, 102(33%) were in sinus rhythm. Cardiopulmonary bypass with fibrillatory arrest and/or cold blood cardioplegia were used. In group I 291 patients (67%0 and in group II 64 patients (54%) underwent direct closure of the defect. In the remaining a patch was used for closure. Results There was 1 early death in group I (0.2%) and four in group II (1.3%) 96% of symptomatic patients in group I and 87% of patients in group II were improved. There were no instances of residual shunt. Follow up ranged from 6 months to 25 years (mean 8.3 yrs) and was 89% complete. Conclusions Closure of isolated secundum ASD is best performed before the patient attains adulthood.     

50岁以上房间隔缺损介入与外科治疗的对比研究

目的　探讨高龄继发孔房间隔缺损 (ASD)病人的最佳治疗方式。方法　收集 5年来 5 0岁以上继发孔ASD行常规外科手术修补 5 3例和同期经导管介入Amplatzer双盘封堵器堵闭ASD 4 2例的资料进行分析 ,两组病例均采用彩色多普勒超声心动图测量心尖四腔心的右室长径、肺动脉压、三尖瓣反流面积、左室舒张末内径 ,左室射血分数等进行对比。结果　外科手术组成功 5 2例 ,成功率 98 1% ,术后出现脑栓塞、心包积液等并发症 13例 ( 2 4 5 % ) ,死亡 1例 ( 1 9% )。导管介入组堵闭成功率 97 6 % ,仅 1例于术后第 4d封堵器脱落移位至肺动脉。两组术后超声心动图复查显示 ,右心室超负荷明显改善 ,右心腔缩小 ,肺动脉高压改善或消失 ;住院天数外科组为 ( 19 8± 12 2 3)d ;介入组 ( 5 0± 2 5 )d。结论　外科手术治疗ASD适应证范围较介入组宽 ,对合并心脏结构明显异常者 ,需行外科手术 ,方可矫正血流动力学异常。介入组术前病例选择非常重要 ,严格掌握适应证范围和尽可能准确地了解ASD的最大直径 ,恰当选择封堵器的大小极为重要 ,经筛选的高龄ASD病人应用经导管介入治疗成功率高、并发症少、疗效好 ,恢复得快。     

超声心动图结合临床评价房间隔缺损介入治疗和外科治疗

目的以18周岁为年龄分界、以20 mm为房间隔缺损(atrial septal defect,ASD)大小分界,比较经导管封堵和外科手术2种治疗方法的安全性和有效性。方法按照患者年龄及房间隔缺损大小分为4组,其中每组又各自按治疗方法分为介入亚组及手术亚组。分别比较每组中不同亚组的技术成功率、并发症、残余分流、手术时间、ICU时间、住院时间、输血量等。结果 (1)相同条件下,介入亚组和外科亚组技术成功率、残余分流发生率方面无显著性差异。(2)介入亚组在并发症发生率和输血量方面低于外科亚组。操作时间、ICU监护时间及住院时间均显著短于外科亚组。(3)四个介入亚组之间的技术成功率、并发症发生率、残余分流发生率、手术时间、住院时间、输血量等差异均无统计学意义。结论 (1)2种治疗方法均安全有效。(2)对于不同年龄、不同大小房间隔缺损患者,只要适应证选择合理,介入治疗因其微创性而更具有优势。(3)ASD介入封堵的优越性不受年龄及缺损大小的限制。     

Delayed aorto-right atrial fistula following percutaneous closure of atrial septal defect

We present the case of a 27-year-old man who underwent percutaneous atrial septal defect (ASD) repair using the Amplatzer^® (St Jude Medical, St Paul, MN, US) septal occluder (ASO). Six weeks later, he presented with heart failure and was found to have an aorto-right atrial fistulation. He required urgent surgical device explantation and repair of the existing ASD using a pericardial patch repair technique. This is the first case to be reported from the UK describing a delayed aorto-right atrial fistula following percutaneous closure using ASO.     

超声心动图在经导管房间隔缺损封堵术中的应用

经导管介入封堵术是治疗房间隔缺损(atrial septal defect,ASD)的重要方法。超声心动图不仅能指导选择封堵器型号,而且可在术前筛查、术中监测及术后复查中发挥重要作用。本研究探讨超声心动图在ASD经导管封堵治疗过程中的应用价值。1资料与方法1.1研究对象2011年10月—     

Surgical closure of atrial septal defect

Background: Closure of ostium secundum atrial septal defect (ASD) vis median sternotomy (MS) is a simple procedure for most cardiac surgeons. Minimally invasive cardiac surgery (MICS) has recently been applied in the management of intracardiac lesions. Methods: We report our experience in surgical closure of isolated ASD via MICS in 60 patients and via MS in 58 patients. There was no difference between these two groups in gender, age, body weight, ratio of systemic to pulmonary blood flow, and pulmonary arterial pressure. Results: The duration of cardiopulmonary bypass was significantly longer in the MICS group than in the MS group [27 to 126 min (42 ± 12) and 14 to 158 min (27 ± 11), respectively; (p < 0.001]. However, the length of incision, incidence of temporary pacemaker wire insertion rate, duration of endotracheal intubation, timing of oral intake, postoperative day drainage amount, incidence of parenteral analgesic injection, postoperative length of stay, and return to normal activity interval were significant shorter and lower in patients of the MICS group than in those of the MS group. All the patients recovered rapidly from the surgery. Follow-up was complete in all patients, with no late complications and no residual shunt. Conclusion: Our results suggest that MICS is a good option for surgical closure of ASD. Received: 4 June 1997/Accepted: 29 October 1997     

复合技术治疗低龄低体重病儿房间隔缺损

目的 介绍一种房间隔缺损(ASD)"复合"技术介入封堵方法,并探讨该手术方法的优缺点.方法 2007年6月至2008年3月,27例婴幼儿房间隔缺损者接受新"复合"技术治疗.其中男15例,女12例.年龄3个月-4岁,平均(2.00±O.22)岁.采用浅镇静加局部麻醉,非气管插管单纯面罩吸氧或喉罩下辅助通气支持,胸骨旁第4肋间小切口,保留胸膜,经胸膜外进入心包腔显露右心房壁,切开右房壁置入ASD封堵器及输送器.心前区或剑突下超声引导进行ASD介入封堵术.结果 全部病儿3d后康复出院,随访0.5-9.5个月,平均(5.9±0.5)个月,仅l例病儿因心包压塞行心包穿刺引流术,余无异常.超声检查没有残余分流或其它并发症.结论 该手术方法创伤小、疗效好,费用低,是婴幼儿ASD病例一种较为理想手术方法.     

经食管超声心动图在外科微创治疗继发孔型房间隔缺损封堵术中的应用

目的探讨TEE在外科微创置入Amplatzer封堵器治疗继发孔型房间隔缺损（ASD）中的应用价值。方法对术前经TTE及TEE筛选的22例继发孔型ASD患者行外科微创封堵术,在TEE完成治疗全程,包括引导、监测和评估,封堵器选择、术中鞘管输送、封堵器释放及术后即刻手术效果评价。结果采用外科微创封堵术成功治疗21例患者,术后即刻TEE显示封堵器位置正常,塑形良好,无残余分流及并发症。TEE测量ASD最大径为（20.14±7.35）mm,与术中所用封堵器大小[（26.66±8.70）mm]相关性良好（r=0.949,P〈0.0001）。1例患者术中TEE显示不适于微创封堵,改行小切口外科修补术获得成功。封堵术后TTE随访3个月,封堵器位置固定,无移位,无残余分流。结论 TEE在继发孔型ASD外科微创封堵治疗术中具有重要应用价值。     

全机器人心脏不停跳下房间隔缺损修补术

目的 总结使用"达芬奇S"(da Vinci S)机器人手术系统,心脏不停跳下房间隔缺损修补或房间隔缺损修补+三尖瓣成形术的经验体会.方法 2009年3月至2010年12月,使用da Vinic S机器人系统,心脏不停跳下完成继发孔型房间隔缺损修补或房间隔缺损修补+三尖瓣成形术40例.患者女23例,男17例;年龄平均(38±13)岁.房间隔缺损直径为1.5～3.5 cm,平均(2.8±1.3)cm,无右向左分流,伴有或不伴有三尖瓣重度关闭不全.手术经股动、静脉及右侧颈内静脉插管建立体外循环.于右侧胸壁打直径为0.8 cm的器械臂孔3个,直径为2 cm工作孔1个,术中不阻断升主动脉,经内窥镜套管持续给予二氧化碳,心脏跳动下,术者于操作台前遥控机器人进行房间隔缺损修补,三尖瓣重度关闭不全患者同期行三尖瓣成形术.其中直接缝合房间隔缺损22例,心包补片修补房间隔缺损18例,同期三尖瓣成形9例.术中食管超声评估修补及三尖瓣成形效果.对比不停跳与心脏停跳下全机器人房间隔缺损修补术的手术时间及体外循环时间.结果 所有患者均成功接受全机器人心脏不停跳下房间隔缺损修补术或房间隔缺损修补+三尖瓣成形术,无体循环气体栓子及残余分流等并发症.不停跳组的手术时间、机器人使用时间或体外循环时间少于停跳组.结论 机器人心脏不停跳下房间隔缺损修补术无需阻断升主动脉,简化了全机器人手术过程,手术效果安全可靠.

Abstract：

Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using "da Vinci S" surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using "da Vinic S" surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After "da Vinci S" syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely.     

Different approaches for minimally invasive closure of atrial septal defects

Background. To improve the acceptance of cosmetic results after closure of atrial septal defects, anterior or lateral thoracotomies are preferred rather than median sternotomies. Along with the availability of minimally invasive techniques, a further reduction in incision length appeared feasible while preserving thoracic stability.

Methods. Various minimally invasive approaches differing in the type of incision and mode of cannulation have been applied under conditions of normothermic ventricular fibrillation. In technique 1 (n = 5), a right parasternal mini-incision was combined with a central aortic and bicaval cannulation. Technique 2 (n = 2) was composed of an anterior submammary mini-incision with femoral arterial and central bicaval cannulation. To optimize the surgical access, the transincisional cannulation of the superior vena cava was replaced by a percutaneous cervical cannulation (technique 3, n = 17).

Results. Effective atrial septal defect closure assessed by intraoperative echocardiography was achieved in all patients. Central neurologic complications were completely absent. Besides temporary atrial fibrillation in one case, no other cardiac complications occurred. There were no cases with complicated wound healing.

Conclusions. Along with modified cannulation techniques and intraoperative echocardiography, minimally invasive techniques can be safely applied for atrial septal defect closure. Submammary incisions were highly accepted and allowed for adequate surgical exposure.     

Amorphous cardiac tumor of right atrium late after atrial septal defect closure

We describe an unusual case of calcified cardiac mass in a patient seventeen years after Dacron patch closure of atrial septal defect. Presenting symptom was prolonged fever and after surgical excision the patient remains afebrile at one year of follow up. The clinical course and histopathological features were consistent with cardiac calcified amorphous tumor (cardiac CAT) Amorphous cardiac tumors are rare non-neoplastic cardiac masses, which are often indistinguishable clinically from true neoplasms. The surgical excision of these tumors is curative and recurrence is unknown.