Institute of Cardiovascular Surgery, Xijing Hospital, The 4th Military Medical University, Xi'an, Shaanxi Province, PR China.
J Thorac Cardiovasc Surg. 2011 Jul;142(1):113-9. doi: 10.1016/j.jtcvs.2010.10.034. Epub 2011 Jan 17.
Transcatheter occlusion of secundum atrial septal defects is a safe and effective alternative to traditional surgical closure; however, it is associated with serious occasional complications and inapplicable to more than 20% of atrial septal defects. In 2000, transthoracic occlusion was pioneered at Xijing Hospital as a novel method of atrial septal defect closure. The purpose of this study is to report the early and mid-term results of the transthoracic occlusion procedure and to evaluate its safety and efficacy.
From April 2000 to April 2006, 268 patients with atrial septal defects were classified into 2 groups: group A (unsuitable for transcatheter occlusion, n = 126) and group B (n = 142). The transthoracic occlusion method used transesophageal echocardiographic-guided atrial septal defects occluder deployment via a right minithoracotomy without cardiopulmonary bypass or fluoroscopy.
Device implantation was successful in 265 patients (98.9%), including 9 elliptical devices in group A. The average size of circular occluders in group A was 38.2 ± 4.2 mm, which was larger than in group B (24.0 ± 4.5 mm) (P < .001). The average procedure time was 37.2 ± 9.2 minutes, the average intracardiac manipulation time was 5.8 ± 3.0 minutes, and the average inpatient stay was 3.2 ± 0.8 days. Twenty-five complications (9.3%) occurred in patients during the follow-up period. No large residual shunting, device embolization, or other severe complications resulted from transthoracic occlusion.
Transthoracic occlusion is a new safe and effective method for atrial septal defect treatment, even for patients with partial atrial septal defects unsuitable for transcatheter occlusion. This hybrid method broadens the indications of atrial septal defect treatment with device occlusion.
经导管封堵继发房间隔缺损是一种安全有效的替代传统手术闭合的方法，但它与严重的偶发并发症有关，并且不适用于超过 20%的房间隔缺损患者。2000 年，西京医院首创经胸封堵作为一种新型的房间隔缺损闭合方法。本研究旨在报告经胸封堵术的早期和中期结果，并评估其安全性和有效性。
从 2000 年 4 月至 2006 年 4 月，将 268 例房间隔缺损患者分为 2 组：A 组（不适合经导管封堵，n=126）和 B 组（n=142）。经胸封堵方法采用经食管超声心动图引导下的房间隔缺损封堵器通过右小开胸术进行部署，无需体外循环或透视。
265 例患者（98.9%）的装置植入成功，其中 A 组 9 例为椭圆形装置。A 组圆形封堵器的平均尺寸为 38.2±4.2mm，大于 B 组（24.0±4.5mm）（P<.001）。平均手术时间为 37.2±9.2 分钟，平均心内操作时间为 5.8±3.0 分钟，平均住院时间为 3.2±0.8 天。在随访期间，25 例患者发生 25 例并发症（9.3%）。经胸封堵未导致大残余分流、器械栓塞或其他严重并发症。
经胸封堵是一种治疗房间隔缺损的新的安全有效的方法，甚至对部分不适合经导管封堵的房间隔缺损患者也是如此。这种杂交方法拓宽了器械封堵治疗房间隔缺损的适应证。
