Clinical Restrospective Study Of Minimally Invasive Closure Of Secondary Atrial Septal Defect Guided By Ultrasound

Objective Through a retrospective analysis of three kinds of treatment of secondary atrial septal defect(atrial septal defect, ASD), including ultrasound guided percutaneous minimally invasive occlusion, ultrasound guided transthoracic minimally invasive occlusion and traditional repair of open heart under cardiopulmonary bypass, to evaluate the advantages and clinical application value of ultrasound guided percutaneous minimally invasive occlusion and ultrasound guided transthoracic minimally invasive occlusion in the treatment of secondary ASD, summarize clinical experience, help clinicians and patients with ASD to choose a more reasonable treatment method.Methods From June 2014 to April 2015, cardivascular surgery department of our hospital minimally invasive percutaneous closured of secondary ASD in 25 cases guided by ultrasound( percutaneous group),minimally invasive transthoracic closured of secondary ASD in 36 cases(transthoracic group), and repaired secondary ASD in 45 cases with open heart suegery under cardiopulmonary bypass(conventional surgical group). Three groups of patients were between the age of 6 years old-42 years old,ASD are at a maximum diameter between 10mm-25 mm.Statistical analysis the three groups' male to female ratio statistics, age, ASD maximum diameter, the success rate of surgery, surgical complications, the number of blood transfusions, operative time,length of hospital stay and hospital costs, to show whether the two methods of percutaneous group and the transthoracic group are safe, effective advantage and worth promoting compared with the traditional surgical group.Resuits1.There is no significant difference in gender, age, body weight and maximum ASD diameter among the three groups.2 1 cases of failure in percutaneous group, the success rate is 96%, all cases in both the transthoracic and traditional surgical groups were successful, the success rate is 100%, there is no significant difference in the success rate of surgery between the three groups.3 The incidence rates of complications in percutaneous group, transthoracic group and traditional surgery group is 4/24, 7/36, 21/45, respectively. The incidence rates of complications in percutaneous group and transthoracic group is basically the same, which is lower than that the rates in traditional surgery group.4 The operation time of percutaneous group, transthoracic group and traditional surgery group was 59.16 + 12.737 min, 90.86 + 10.718 min and 120.7 + 12.926 min,respectively, the difference was statistically significant, the operation time of percutaneous group was the shortest, and the length of operation time of transthoracic group was slightly longer, the longest time in the traditional surgery group.5 The postoperative hospitalization days of percutaneous group, transthoracic group and traditional surgery group were 3 + 0.577 days, 5 +0.586 days, 8 + 0.522 days, respectively, the difference was statistically significant, The length of postoperative hospitalization in the percutaneous group was the least, and the number of days of postoperative hospitalization in the transthoracic group was slightly more than that in the percutaneous group, and the number of days of postoperative hospitalization in the traditional surgery group was the most.6 The rates of blood transfusion of percutaneous group, transthoracic group and traditional surgery group were 0/24, 5/36 and 18/45, respectively, in the operation and after the operation. The difference was statistically significant, the probability of blood transfusion in the percutaneous group and the transthoracic group were relatively small, and it was significantly less than that of the traditional surgical group.7 The hospitalization costs of percutaneous group, transthoracic group and traditional surgery group were 3.5144 yuan+ 0.07779, 3.2058+ 0.06317 yuan, 2.6858 yuan + 0.06017, the difference was statistically significant, the cost of hospitalization in the percutaneous group was the most, and the cost of the traditional surgery group was the least.Conclution1 Traditional repair of open heart under cardiopulmonary bypass, ultrasound guided transthoracic minimally invasive occlusion and ultrasound guided percutaneous minimally invasive occlusion are all safe and effective in the treatment of secondary ASD.2 Ultrasound guided transthoracic closure of ASD, especially the ultrasound guided percutaneous ASD closure has the advantages of little trauma, short operation time, less complications, low blood transfusion rate, rapid recovery, compared with traditional repair of open heart under cardiopulmonary bypass, and is worthy of wide clinical application. For compliance with surgical indications of secondary ASD should be given priority to consider the application of ultrasound guided ASD closure,in particular, should be given priority to select the ultrasound guided percutaneous ASD closure.