Non-fluoroscopic percutaneous transcatheter closure of atrial septal defects in children under transesophageal echocardiographic guidance
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Abstract:
This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children.We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients' mean age was 60.09 ± 36.42 months (13-182 months), and their mean body weight was 20.16 ± 10.04 kg (9-77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms.The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58 ± 5.31 mm (3-28 mm), and the mean size of the occlusion device was 16.07 ± 5.29 mm (6-36 mm). The mean procedural times were 13.33 ± 2.82 minutes (6-16 minutes). The mean hospitalization costs were 27,259.66 ± 2507.04 RMB (25,200.00-33,911.45 RMB). The mean postoperative hospital stay was 3.22 ± 0.53 days (3-5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation.Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.Keywords:
Cardiac catheterization
The classic subxiphoid pericardial window technique and the newer, minimally invasive percutaneous fluoroscopy- controlled method of surgical treatment of pericardial effusions and/or tamponade are reviewed and compared based on 12 years of surgical experience. Since 1988, 114 patients underwent surgery for treatment of pericardial effusion and/or tamponade. The classic subxiphoid approach was used on 66 patients, and since 1993, the percutaneous tube pericardiostomy method was employed on 48 patients. In choosing a method for pericardial decompression, disease etiology and patient characteristics must be considered as well as the experience of the surgeon.
Pericardial window
Chest tube
Pericardiocentesis
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To compare the efficacy of percutaneous atrial septal defect (ASD) closure guided by transesophageal echocardiography (TEE) or guided by fluoroscopy in pediatric patients.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.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).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.
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Objective:To evaluate the treatment efficiency of transcatheter closure of secundum atrial septal defect(ASD) using Amplatzer occluder device.Methods:There were 14 patients,The age was 4～43 years (mean age 27.4 years).The defected diameter of ASD was 8.0～28.0 (16.4±6.0)mm shown by echocardiography before interventions.Each case with ASD was occluded using Amplatzer occluder device through the percutaneous procedure under guiding fluoroscopy and echocardiography,and observed at residual shunt. Results:The mean balloon stretched diameter of the ASD in 14 patients was 7.0～36.0(19.0±7.0)mm.The diameter of the occluder selected was 8.0～38.0(20.0±6.0)mm.13 patients was treated successful,1 case could not treated by Amplatzer device residual shunts,there was no residual shunt 1 week after the procdures.Conclusion:Transcatheter closure of secundum ASD using Amplatzer occluder device was an efficient for nonsurgical method for patients of any group.
Septum secundum
Heart septal defect
Cardiac catheterization
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Objective To summarize the experience of applying microinvasive surgical transthoracic occlusion in the treatment of patent ductus arteriosus (PDA). Methods A total of 38 patients with PDA were given microinvasive surgical transthoracic occlusion. The diameter of PDA was 4.5~18.3 mm. An incision of 2~3 cm in length was made on the left anterior chest. A special occluder was inserted to close PDA under the guidance of transesophageal echocardiography. Results All the patients were successfully occluded. Pneumonia happened in two patients after the procedure. Moderate amount of pericardial effusion occurred in one patient. They were cured. Echocardiography at three months after operation showed significant relief of pulmonary artery hypertension, from (55± 20) mmHg to (36±15) mmHg (P0.05). The patients were followed up for 3~24 months, (14.5±8.2) months in average, no dislocation of the device or arterial shunt was found. Conclusion Microinvasive surgical transthoracic occlusion is safe and efficient for the closure of PDA, which is suitable for patients in various age ranges.
Ductus arteriosus
Left pulmonary artery
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Background. Percutaneous closure of secundumtype atrial septal defect (ASD II.) is becoming an increasingly widespread alternative to surgical closure. We report our initial clinical experience with the percutaneous closure of ASD II. using Amplatzer Septal Occluders (ASO) in Slovenia. Patients and methods. Fifty consecutive patients with ASD II. were evaluated for transcatheter closure with ASO using both transthoracic (TTE) and transesophageal echocardiography (TEE). Transcatheter closure was performed under general endotracheal anesthesia with simultaneous fluoroscopy and TEE guidance. The stretch defect diameter was measured using an Amplatzer sizing balloon catheter. The ASO having a 2–4 mm larger diameter than the stretched defect diameter was selected for defect closure. Follow-up was scheduled 10 min, 24 hours, 1 month, 3 months, 6 months, 1 year and then annually after the procedure. Results. Eight patients (16%) with deficiency of the posterior, inferior anterior, or inferior posterior rim were not deemed suitable for transcatheter closure and were referred for surgery. Fourteen patients (28%) had centrally positioned defects, 23 patients (46%) defects with a deficient superior anterior rim, 3 patients had multiple defects, while 2 patients presented with atrial septal aneurysm: 1 associated with a single perforation and 1 with multiple perforations. So far, cardiac catheterization has been performed in 24 patients, while the remaining 12 patients are waiting cardiac catheterization. During cardiac catheterization, 1 additional patient was excluded from percutaneous closure due to an additional defect unsuitable for percutaneous closure. Therefore, percutaneous closure was attempted in 23 patients. In a single patient we retrieved an inadequately positioned occluder and referred the patient for elective surgical closure. A large Eustachian valve caused this single failure of occluder positioning in our series. In the remaining 22 patients successful implantation of ASO was achieved. The correct position of the occluder was achieved in 13 patients at the first attempt, while in 9 patients several attempts were necessary. The complete closure rate rose from 70% at the end of the procedure to 95% at the latest follow-up. Regression of right ventricular M-mode echocardiographic dimension was evident from 26.4 ± 3.1 mm before closure to 21.7 ± 4.2 mm at 1 month (p < 0.05), and to 19.1 ± 3.2 mm (p < 0.05) at 3 months follow-up. Late complications were not detected during a 12-month follow-up. Conclusions. Percutaneous closure of ASD II. using ASO is a safe and effective alternative to surgical closure. Up to 80% of ASD II. are amenable to percutaneous closure using ASO. Careful patient selection, precise stretch defect diameter measurement, selection of proper occluder size and precise positioning of the occluder are crucial for successful defect closure. Additional clinical experience in a larger number of patients and long-term follow-up results are required to further support our statements.
Septum secundum
Cardiac catheterization
Heart septal defect
Perforation
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Cardiac catheterization
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Patent foramen ovale (PFO) is a potential risk factor for ischaemic stroke in young individuals. An interventional method of secondary stroke prevention in PFO patients is its percutaneous closure.To assess safety and effectiveness (i.e. lack of residual shunt) of percutaneous PFO closure in patients with history of cryptogenic cerebrovascular event.149 patients (56 men/93 women), aged 39 ± 12 years, underwent percutaneous PFO closure. The implantation was performed under local anaesthesia, guided by trans-oesophageal echocardiography (TEE) and fluoroscopy. Follow-up trans-thoracic echocardiography (TTE) was performed at 1 month and follow-up TEE at 6-months. In cases of residual shunt, additional TEE was performed after ensuing 6 months.Effective PFO closure (no residual shunt) was achieved in 91.3% patients at 6 months and 95.3% patients at 12 months. In 2 patients transient atrial fibrillation was observed during the procedure. In 2 patients, a puncture site haematoma developed and in 1 patient superficial thrombophlebitis was noted. In 1 patient a small pericardial effusion was observed, which resolved at day 3 post-procedurally, after administration of non-steroidal anti-inflammatory drugs.Percutaneous PFO closure seems to be a safe procedure when performed in a centre with adequate expertise with regard to these procedures.
Paradoxical Embolism
Right-to-left shunt
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Objective: To evaluate the value of CT fluoroscopy to make percutaneous lung biopsy.To increase the puncture success rate and the diagnosis accurate rate in the mass or nodular of lung.Method: To study the mass or nodular of lung which make percutaneous lung biopsy by CT fluoroscopy,follow up their pathological diagnosis and surgical results. Results: 31 cases underwent percutaneous lung biopsy by CT fluoroscopy.29 cases succeed in making percutaneous lung biopsy,2 cased failed and made second percutaneous lung biopsy.The puncture success rate was 94%,the pathological diagnosis accurate rate was 100%.Conclusion: CT guidance percutaneous lung biopsy is an accurate method in puncture,which has high accurate rate in pathological diagnosis.And it is a major method in the diagnosis,differential diagnosis of the mass or nodular of lung.
Lung biopsy
Percutaneous biopsy
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