| BACKGROUND:With the progress of society and the improvement of the overall material and cultural standard of living,people no longer only pay attention to the success rate of surgery,the cost of surgery,surgical complications and other issues in the treatment of diseases,but also put forward higher requirements in the aspects of surgical trauma,aesthetic incision,recovery time and so on.And the advent of minimally invasive treatments has catered to the public.In the late 1990s,minimally invasive treatment of congenital heart disease(CHD)gradually emerged in China.It is favored by doctors and patients because of its characteristics of small trauma,quick recovery and accurate curative effect.It is the change of people's concept of diagnosis and treatment that drives the improvement of medical technology and the innovation of medical equipment.The interventional treatment of secondary atrial septal defect(asd)has undergone percutaneous occlusion under DSA guidance,small incision occlusion under esophageal ultrasound(TEE)guidance,small incision occlusion under TEE guidance,percutaneous occlusion under TEE guidance,all of which reflect the minimally invasive treatment methods,and these treatment methods are still widely used in clinical practice.The appearance of percutaneous closure of atrial septal defect guided by transthoracic ultrasound under local anesthesia(TTE)further meets the needs of people,especially in the treatment of adult atrial septal defect.Transthoracic ultrasound has a huge advantage in the assessment of cardiac structure and basic function,and is routinely used for the diagnosis of structural heart disease and for post-cardiac review.It can observe the structural changes,functional states and hemodynamic changes of the heart in real time and clearly.The psychology of adults is basically mature and independent.Under local anesthesia,the body can remain motionless for a certain period of time,which is convenient for operation.All Secondary Tricuspid Valve Insufficiency(STVI)is a common complication of atrial septal defects.The mechanism is:the congenital the pathogenesy of the left atrial hemodynamic state changes,the early part of the left atrial blood by the defect of the interatrial septum shunt to right,right in front of the load increasing,right inside the blood volume increase,in the room on the right side for a long time under the influence of tension,tricuspid ring adaptive expansion occurs,causing tricuspid relatively closed.When patients have other cardiac lesions requiring surgical treatment,moderate to severe tricuspid valve closure insufficiency is often performed with tricuspid valvuloplasty to improve tricuspid function and ensure normal blood flow in the heart.At present,there are some controversies about the indication and prognosis of functional tricuspid insufficiency in the interventional treatment of atrial septal defect.Therefore,in the clinical work,we summarized this situation,in order to provide a certain theoretical basis for the study of its mechanism and a certain reference for clinical treatment.This study is introduced in the following two parts:SECTION ONE:Comparison of transthoracic ultrasound percutaneous closure and surgical thoracotomy repair in the treatment of adult atrial septal defect.Objective:To evaluate the efficacy of percutaneous transthoracic ultrasound in adult atrial septal defect.Methods:In this study,a total of 129 adult patients with secondary ASD who underwent transthoracic ultrasound percutaneous occlusion under local anesthesia and traditional surgical repair in the first affiliated hospital of Zhengzhou University from January 2015 to January 2019 were collected.Among them,there were 58 cases in the transthoracic ultrasound group and 71 cases in the surgical thoracotomy group.By means of two groups of patients with preoperative patients' gender,age,weight,pulmonary artery pressure,hemoglobin content,right room area,heart,tricuspid valve function and observing index and postoperative surgical success rate,operation duration,extracorporeal circulation time,postoperative hospitalization duration,postoperative residual shunt 1 week,1 year postoperative residual shunt,hemoglobin variation,pulmonary artery pressure variation,right room area variation,tricuspid valve function,improved cardiac function,improve postoperative complications such as observation index statistics within 1 year.Comparative analysis of the efficacy of percutaneous transthoracic ultrasound in adult atrial septal defect.Results:In the thoracotomy group,56 cases were successfully operated,with a success rate of 96.55%,2 cases of failure,and 1 case of thoracotomy.One case was aborted.Degree ? atrioventricular block was found during the operation and returned to normal after withdrawal of the blockade.All the operations in the surgical thoracotomy group were successful,with a success rate of 100%.Compared with the preoperative results,pulmonary artery pressure and right atrial area of the two groups decreased significantly after surgery,and the difference of pulmonary artery pressure and right atrial area of the patients before and after surgery was statistically significant(P<0.05),and there was a significant correlation between pulmonary artery pressure and right atrial area before and after surgery.The duration of surgery,extracorporeal circulation and postoperative hospitalization in the thoracotomy group were significantly shorter than those in the thoracotomy group during postoperative hospitalization,and the differences in the duration of surgery,extracorporeal circulation and postoperative hospitalization were statistically significant(P<0.05).The reduction of hemoglobin in the transthoracic ultrasound blocking group was significantly lower than that in the surgical thoracotomy group,and the difference between the two groups before and after surgery was statistically significant(P<0.05).There was no significant difference in residual fractionation between the two groups within 1 week after surgery(P>0.05).During postoperative follow-up,there were no statistically significant differences between the two groups in pulmonary artery pressure reduction,right atrial area reduction,tricuspid valve function change,cardiac function change,residual fractional flow rate and postoperative complication rate 1 year after the operation(P>0.05).Conclusion:Under local anesthesia via chest ultrasound pure percutaneous closure in the treatment of ASD in the success rate of surgery,the right room area is narrow,reduce pulmonary artery pressure and cardiac function(NYHA),tricuspid valve function improvement,postoperative complications and surgical thoracotomy to repair the there was no significant difference,but in the short operation time,length of hospital stay,reduce the bleeding has significant advantages,and avoid the extracorporeal circulation and general anesthesia.In addition,strict control of surgical indications can effectively improve the success rate of surgery and improve the prognosis of patients.SECTION TWO:Outcome of secondary tricuspid insufficiency after occlusion of adult atrial septal defect.Objective:In adults,atrial septal defect is often associated with secondary tricuspid insufficiency.However,there are few studies on the prognosis of tricuspid insufficiency after atrial septal defect closure.In this study,the outcomes of postoperative tricuspid insufficiency were statistically analyzed by comparing the observed indicators before and during the follow-up period.Methods:In this study,all the subjects were adult patients with secondary atrial septal defect who underwent transthoracic ultrasonic-guided percutaneous occlusion under local anesthesia in the first affiliated hospital of zhengzhou university from January 2015 to January 2019,a total of 36 patients,all of whom had tricuspid valve insufficiency of different degrees before surgery.Among them,17 cases were mild,12 cases were moderate,and 7 cases were severe.Through the statistics of right atrial area,right ventricular diameter,pulmonary artery pressure,left ventricular ejection fraction(LVEF),cardiac function(NYHA classification)and tricuspid valve function of patients before and after 3 months and 1 year,the postoperative outcome of tricuspid valve insufficiency was analyzed.Results:In the whole group,the degree of tricuspid valve insufficiency after operation was significantly improved compared with that before operation.Pearson's linear correlation analysis showed that the degree of tricuspid valve insufficiency was not linearly correlated with atrial diameter and body weight,but was linearly correlated with age,but the correlation was small.In addition,the present study showed that after the closure of atrial septal defect,the right atrial area,right ventricular diameter and pulmonary artery pressure were significantly improved,and the improvement degree was significant within 3 months after the operation,and there was also a certain degree of improvement from 3 months to 1 year after the operation.Conclusion:After ASD occlusion,secondary tricuspid valve closure was significantly improved,and the reduction of right atrial area,right ventricular diameter,and pulmonary artery pressure may be involved in this process.This suggests that in patients with secondary tricuspid insufficiency,percutaneous ASD occlusion by transthoracic ultrasound under local anesthesia alone may be valuable. |
PDF Full Text Request