A Comparative Study Of Cardiac Remodeling Before And After Percutaneous And Transthoracic Atrial Septal Defect Closure Under Ultrasound Guidance

Background and Objective: There are many methods for the treatment of atrial septal defect,including transesophageal ultrasound-guided percutaneous closure,transthoracic catheterization,percutaneous transcatheter closure under X-ray fluoroscopy and traditional surgical treatment.Traditional extracorporeal circulation thoracotomy has been used as the first choice to treat tens of thousands of patients with atrial septal defect(ASD).However,the open-heart surgery has a lot of trauma and bleeding,and the operation scar obviously leads to the huge physiology of the patient after operation.Psychological stress.For example,atrioventricular block,chylothorax,phrenic nerve injury,arrhythmia and so on exist in the traditional repair of atrial septal defect by extracorporeal circulation.Postoperative complications include pericardiotomy syndrome,wound infection,extracorporeal circulation-related neurological sequelae and so on.The operation wound is big,the healing time is long,the incision scar is also big.With the advent of interventional techniques,more and more patients with atrial septal defect(ASD)begin to undergo transcatheter closure.Ultrasound-guided percutaneous occluder in operating room has the following advantages:(1)the absence of cardiopulmonary bypass(CPB),)reduces the complications of CPB and traditional surgery;(2)minimally invasive and beautiful;(3)eliminating the risk of serious injury to the body of medical workers and patients caused by X-ray radiation and leading to cancer,(4)avoiding the damage of cardiopulmonary bypass to the patient's blood system,coagulation function and vascular endothelial cells.(5)when the occluder was removed,it could be recovered or re-occluded again or transferred to open chest surgery in time,(6)for the complicated congenital heart disease which was missed or misdiagnosed before operation,the operation mode could be changed to open chest repair.(7)the operation is simple and can improve the safety and accuracy of the operation.Transesophageal ultrasound can observe the position of the occluder,the success of the occluder and the blood flow around the defect in real time.It plays a more and more important role in minimally invasive closure of atrial septal defect.With the gradual development of percutaneous atrial septal defect closure guided by transesophageal echocardiography in China,the technique is more mature.In recent years,there are more and more patients who benefit from transesophageal transcatheter closure under the guidance of ultrasound without radiotherapy or fluoroscopy,the success rate is greatly improved,and the cost is obviously reduced.So far,compared with the traditional transthoracic atrial septal defect closure under the guidance of transesophageal echocardiography,the two procedures are closely related,and a clinical comparison of the two methods has also been studied.However,there is a lack of statistical comparative study of cardiac remodeling before and after transthoracic and percutaneous closure.The purpose of this study was to compare whether there were significant differences in cardiac remodeling between percutaneous and transthoracic closure of atrial septal defect under transesophageal ultrasound guidance.Methods:With transesophageal echocardiography,132 patients with congenital atrial septal defect treated in affiliated Hospital of Guilin Medical College from September 2012 to September 2019 were treated with transthoracic or percutaneous minimally invasive closure under simple ultrasound guidance.Preoperative echocardiography showed that all patients had secondary atrial septal defect and no other cardiac malformations or organ dysfunction.Among them,27 cases(percutaneous group)underwent percutaneous transcatheter closure of atrial septal defect under the guidance of transesophageal echocardiography,and 105 cases(Transthoracic group)underwent transthoracic atrial septal defect closure under the guidance of transesophageal echocardiography alone as control group.Before operation,1 month after operation,and 1 year after operation,the results of echocardiography were calculated.SPSS 18 statistical software was used to analyze the data of each group.The data of each group were expressed by `x ±s: the comparison of cardiac remodeling before and after ASD transcatheter closure was carried out,and the matched sample t test was used for the comparison between the two groups.The comparison of cardiac remodeling before and after transthoracic closure of ASD was compared with that before and after transthoracic occlusion.there was significant difference between the two groups by independent sample t test(P < 0.05).Results:Comparison of cardiac color Doppler ultrasound results before operation,1 month after operation and 1 year after operation in patients with esophageal ultrasound guided by ultrasound: the diameter of right atrium,left ventricle,right ventricle and pulmonary artery systolic blood pressure in patients with transesophageal ultrasound were significantly different from those before operation.The difference was statistically significant(p < 0.05),but there was no significant difference between the transthoracic group and the transthoracic group(p ? 0.05).Conclusions:1.Transcatheter closure of atrial septum defect under the guidance of esophageal ultrasound was more obvious 1 month after operation and 1 year after operation than that before operation.2.There was no significant difference in cardiac remodeling between transcatheter closure of atrial septum defect guided by esophageal ultrasound and transthoracic atrial septum defect occlusion.