超声引导下经胸微创封堵治疗先心病的远期随访结果分析

目的 总结超声引导下经胸微创封堵治疗儿童先心病的临床经验及随访结果,探讨其远期疗效及安全性.方法 回顾性分析2007年3月至2017年12月在青岛大学附属妇女儿童医院心脏中心行食道超声引导下经胸微创外科封堵术治疗的先心病患儿临床资料,并进行长期随访.随访截至2020年12月,随访内容包括超声心动图、心电图、临床症状、并...

Minimally invasive transthoracic device closure of congenital heart disease navigated by transesophageal echocardiogram:Long-term follow-up results

Objective To summarize the clinical experience and long-term follow-up result of minimally invasive transthoracic device closure(MITDC)of congenital heart disease(CHD),and evaluate its long-term efficacy and safety.Methods A retrospective review was performed on the clinical data of patients with CHD undergoing MITDC navigated by transesophageal echocardiogram(TEE)from March 2007 to December 2017.The patients were continuously followed up by December 31,2020,with clinical symptoms,echocardiogram and electrocardiogram(ECG).The complications,countermeasures and prognosis were then analyzed.Meanwhile,the patients of ventricular septal defect(VSD)were divided into different groups according to age,weight and device types,before comparison of common complications,such as emerging aortic regurgitation(AI),tricuspid regurgitation(TI)and right bundle branch block(RBBB).Results A total of 752 cases were enrolled in this study.There were 691(95.05%)of 727 VSD cases,19 atrial septal defect(ASD)cases and 6 cases combined with cardiac abnormalities undergoing successful closure.Follow-up in 684 patients(95.7%)ranged from 3 to 13 years without a single death.During the follow-up period,48 self-cured in 53 cases of residual shunts;2 in 8 cases of emerging slight or mild aortic regurgitation recovered;1 had delayed pericardial effusion;13 recovered and 2 developed to mild regurgitation in 34 cases of emerging mild tricuspid regurgitation or regurgitation progressing from mild to moderate;1 case of emerging intermittent complete atrioventricular block is being followed up and 2 cases of primary complete atrioventricular block recovered;1 in 2 cases of emerging left bundle branch block recovered;5 in 38 cases of emerging right bundle branch block recovered.The eccentric and saddle shaped devices were easier to lead to aortic regurgitation(P<0.05),whereas no correlation between device types and TI or RBBB occurrence rate was observed(P<0.05).There was no significant differences on the common complications between different age and weight groups(P<0.05).Among the 6 cases combined with cardiac abnormalities,1 with emerging mild aortic regurgitation recovered after 1 year.Conclusion MITDC of CHD integrats the advantages of both traditional surgical closure under cardiopulmonary bypass operation and transcatheter device closure.Currently the long-term follow-up result is promising,while patients still require life cycle follow-up and health management.