| Background: Congenital Heart Disease(Congential Heart Disease,CHD)refers to pathological changes in the anatomical structure of the Heart caused by abnormal cardiac structure and cardiovascular development during early embryonic development.With the development of medical technology,as well as the improvement of doctors’ and patients’ requirements for surgical trauma,many minimally invasive surgical methods,such as right subaxillary small incision,parasternal small incision and thoracoscopic atrial defect repair,have been gradually applied in clinical practice.At the same time,more minimally invasive surgical methods such as X-ray guided percutaneous closure,simple ultrasound(TTE)guided percutaneous closure,esophageal ultrasound(TEE)guided percutaneous closure,esophageal ultrasound(TEE)guided small incision closure have gradually replaced traditional surgical procedures and achieved good clinical results.Among them,X-ray-guided percutaneous ASD closure is still the most widely used minimally invasive surgical method in clinical practice.Objective: Patients with secondary perforated ASD who were evaluated by ultrasound and suitable for sealing treatment were selected from the cardiac vascular surgery department of our hospital,and patients in the ultrasound group and X-ray group were selected.The success rate of surgery,operation time,complication rate,radiation exposure time and radiation amount of the two groups were counted,and the differences between the two groups were compared to analyze the causes.The advantages and disadvantages of the two methods in the treatment of secondary orifice ASD were analyzed.Methods: In this study,patients admitted to the department of Cardiology and Vascular Surgery of our hospital who were diagnosed as secondary pore ASD from November 2020.11 to December 2021.09 were selected,and other cardiac malformations were excluded.Patients suitable for occlusion were determined by strict evaluation of cardiac color doppler ultrasound and interventional occlusion was completed.They were numbered according to the time of admission,and patients in X-ray group and ultrasound group were selected according to random number table.The general data of age,sex,weight and defect size were collected.The operation success rate,operation time,residual shunt rate,complication rate,ray exposure time and ray quantity were calculated.Results: 1.A total of 160 patients were collected and 80 patients were selected from the X-ray group,including 77 successful patients and 3 failed patients.The cause of the failure was residual shunt after intraoperative closure.Multihole ATRIAL septal defect was considered,and the multihole atrial septal defect was diagnosed by surgical repair at an appropriate time.Residual shunt of 2mm was found in 1 of the 77 cases,and no residual shunt was found in color doppler echocardiography 3 months after surgery.Among them,11 patients had headache and vomiting after surgery,and 1 patient had abdominal pain,and all symptoms disappeared before discharge.Of the 80 patients in the ultrasound group,71 were successful and 9 failed.Among them,X-ray guidance was successfully transferred in 3 cases,but the reason for the failure was poor intraoperative sound transmission and ultrasound guidance could not be carried out.For the remaining 6 cases,residual shunt still existed after intraoperative closure.Multihole ATRIAL septal defect was considered,and the multihole atrial septal defect was diagnosed by surgical repair at an appropriate time.Among the 71 successful cases,1 patient had a 2mm residual shunt and 1 patient had a 3mm residual shunt.No residual shunt was found in cardiac color doppler echocardiography 6 months after surgery.Among them,4 patients had headache and vomiting after surgery,and 2 patients had abdominal pain,and all symptoms disappeared before discharge.2.Comparing the two cases,there was no significant difference in the success rate and the clinical data such as age,sex,weight,postoperative residual shunt rate were higher than 0.05.Compared with the ultrasound group,the x-ray group was shorter(p <0.05).Neither group had accidents of cardiac perforation,pericardial effusion,vascular injury and blocked umbrella shedding.3.The maximum value and minimum value of surgical ray exposure time of patients in X-ray group were 479 s,62s and 171.61 s respectively.The maximum ray exposure was 40 m Gy,the minimum was 3MGy,and the mean was 15.18 MGy.Conclusion: There was no significant difference in the surgical success rate between the ultrasound group and the X-ray group.X-ray-guided lower chamber closure has short operation time,small defect diameter and small closure umbrella diameter,which can monitor the intraoperative situation in real time.It is more minimally invasive and safer for patients,but it has certain radiation for patients and medical staff.Ultrasound guided lower chamber lack of sealing can avoid radiation,can observe the distance between sealing umbrella and each valve and vein,but can not monitor the intraoperative delivery device out of shape,also need to be completed with the cooperation of experienced ultrasound doctors,high requirements for surgeons,long learning cycle;Meanwhile,for patients with large body weight,the intraoperative acoustic transmission is poor,and the operation is difficult to carry out.These two different guidance methods have their own advantages and disadvantages.In clinical practice,the most suitable way for patients should be selected according to preoperative examination,and personalized treatment should be carried out for each patient to achieve the most ideal surgical results. |
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