Study On The Prognosis Of Iatrogenic Atrial Septal Defect After Atrial Fibrillation By TEE And TTE

Objective : Use transesophageal echocardiography(TEE)and two-dimensional transthoracic echocardiography(TTE)to observe and evaluate the iatrogenic atrial septum caused by the use of a larger diameter sheath(14F～15F)to puncture the atrial septum during interventional surgery in patients with atrial fibrillation.The healing of defects(i ASD),and analyze the factors that affect its healing.Methods : A total of 71 patients with atrial fibrillation in the department of cardiology of our hospital from March 2017 to June 2020 were collected,including 45 males and 26 females,aged from 48 to 83 years old,with an average age of 65.39±8.60 years old.All patients had a history of atrial fibrillation confirmed by electrocardiogram before hospitalization and voluntarily received relevant interventional therapy and postoperative examinations.Patients with left atrial appendage thrombosis,intolerable transesophageal ultrasound,previous atrial septal puncture,congenital atrial septal defect or other complex congenital heart disease and idiopathic cardiomyopathy were excluded;patients with pregnancy,severe cardiac dysfunction or other systemic or systemic diseases were excluded;patients with frequent premature beats or other factors interfering with image quality were excluded.The results of echocardiography before operation,approximately 3 months and 6 months after operation were collected.According to whether iatrogenic atrial septal defect still existed approximately 3 months after operation,the patients were divided into two groups: healing group and non-healing group.Collect the general information of the two groups of follow-up patients: including gender,age,height,weight,body mass index(BMI),whether they have a history of smoking,whether they have diabetes,hypertension,etc.,type of atrial fibrillation,operation method,number of intraoperative atrial septal puncture,international normalized ratio(INR),etc.The data were collected by Philips Doppler echocardiography(Philips EPIC 7C or Philips i E33)and two-dimensional probe X5-1(esophageal probe X7-2t).The measured indexes Included:1.Collect the general information of the two groups of follow-up patients,including gender,age,body mass index(BMI).Clinical indicators include hemoglobin(Hb),serum albumin(ALB),serum cholesterol(TC),international normalized ratio(INR),smoking history,diabetes and hypertension,type of atrial fibrillation,puncture sheath size,number of atrial septal punctures and punctures Location.2.Routine transthoracic echocardiography:(1)Routine transthoracic echocardiography: left atrial end systolic anteroposterior diameter(LA),left ventricular end diastolic diameter(LVDD),left ventricular ejection fraction(LVEF),left ventricular short axis shortening rate(FS),heart beat SV,semi-quantitative mitral valve,tricuspid regurgitation degree,right heart enlargement,pulmonary hypertension,etc.(2)Transesophageal echocardiography:Observe the continuity of the atrial septum,the defect location,and the direction of blood flow across the septum through two-dimensional,three-dimensional,and color Doppler modes at45°and 90°respectively,and collect and store data image.Results:1.The results of general data showed that the content of hemoglobin(Hb)in the healing group was higher than that in the non-healing group(P<0.05),but there was no significant difference in other factors(P>0.05).2.Comparison results of ultrasonic parameters: The size of the left atrium before operation and the degree of tricuspid regurgitation after the operation were different between the groups and the difference was statistically significant,that is,the size of the left atrium and mild or more tricuspid regurgitation in the non-healing group were larger than those in the other group(P<0.05).3.The results of influence factor analysis showed that decreased hemoglobin content,larger left atrium before operation and severe tricuspid regurgitation after operation were the risk factors affecting i ASD healing(P<0.05).For every 1g/L decrease in hemoglobin,the risk of i ASD non-healing increases by 5.4%;for every1 mm increase in the size of the left atrium before surgery,the risk of non-healing increases by 20.8%;Follow-up showed that the more obvious the tricuspid regurgitation was,the more difficult it was for i ASD to heal(OR=3.971).4.During the follow-up period,1 case of migraine and 1 case of unexplained transient ischemic attack were found in the unhealed group,but no related right-to-left shunt or right ventricular overload was observed.This suggests that the occurrence of long-term adverse clinical events of i ASD cannot be ruled out,which is worthy of attention.Conclusions: It has been observed that the iatrogenic atrial septal defect after atrial septal puncture in patients with atrial fibrillation has an obvious tendency to close spontaneously.The risk factors for the healing of iatrogenic atrial septal defect are hemoglobin content,left atrium before operation,and tricuspid regurgitation after surgery.The long-term existence of i ASD may cause migraine and other clinical manifestations,and the correlation is worthy of continuous follow-up study.