Fetal atrial septal room to the left side of the inflation process? What does it mean ah? Doctor!

This is the case, atrial septal defect for the most common congenital heart disease one of [1], not on the current clinical interventional treatment of atrial septal defect closure of the main pump in the open repair defect, although the effect of surgery, but Trauma, long recovery time. Hospital in 2000 by using a small chest incision blocking techniques involved in the treatment of atrial septal defect, the better effect. This article aims to sum up in May 2001 -2005 in September in our hospital 206 cases of off-pump through a small chest incision in the treatment of atrial septal defect surgical experience, sum up their clinical effects.
1 clinical data and methods
1.1 General information on 206 cases of this group, 126 men and 80 women. Ages 3 to 62 (an average of 15 ± 6.21) years old and weighing 15.6 ~ 66.0 (39.7 ± 13.1) kg. Atrial septal defect diameter of 4.8mm ~ 44.3 mm, which diameter> 30 mm 100 cases. 206 cases of lower-chamber 89 cases of atrial septal defect, atrial septal defect with two holes 9, 108 cases of central type, atrial septal defect with bulging tumor in 2 cases.
Case selection criteria: cardiac ultrasound atrial septal defect in the superior vena cava, the inferior vena cava, mitral and pulmonary vein opening the edge of flaws; too large atrial septal defect, atrial septal defect part of the edge of <4 mm.
Case rule out the standard: the edge of atrial septal defect <4 mm, there is a certain risk involved in the operation were.
1.2-way HP1500 color Doppler ultrasound diagnostic apparatus, the probe frequency of 7.5MHz, dual-plane esophageal probe diameter 6mm, transesophageal echocardiography were observed atrial chamber view of the two, four cavity Xiphoid under the apex and large blood vessels short Shaft section, measuring atrial septal defect from the superior vena cava, the inferior vena cava, the posterior wall of the aorta and pulmonary vein openings, the coronary sinus and the mouth of the mitral ring distance. General anesthesia in the operation, carried out under endotracheal intubation, the ultrasound probe into the esophagus. Patients taking supine position, the right side of the booster 30 ° ~ 45 °, the right side of the intercostal No. 4 for 2 ~ 3 cm incision, the exposed right atrium, sodium 1mg kg-1 intravenous injection, activated clotting time (actived coagulation time, ACT)> 250s.
1.2.1 surgical incision and into the catheter: in the right atrium wall hanging, and Latin America to cut exposure to the full, the purse-string suture, about the diameter of 8mm. The use of dual-chamber push the central catheter in the purse-string suture needle into the right atrium and esophagus in real-time ultrasound scan image-guided catheter delivery will be postponed by the atrial septal defect close to the vertical angle of the left atrium into the left lung or vein opening, the push to send catheter Into the memory nickel-titanium alloy atrial septal defect occluder.
1.2.2 plugging umbrella model options: occluder atrial septal defect diameter than the large diameter 4 mm; defects, such as up and down track after track with the big difference between impairment and who are considered large selection of closed-oval.
1.2.3 blocking the release of the umbrella: the release of ultrasound-guided parachute pull to the left atrial septal defect after the taut, repeatedly push and pull no closer to confirm shift, the release of the right umbrella, Doppler echocardiography color flow imaging showed no Blood streaming through every other, the umbrella sealing closure does not affect the mitral valve and coronary vein, the pulmonary vein after opening, the release of closure, push from the catheter.
1.2.4 related chest: the purse suture ligation, to stop bleeding, interrupted suture pericardial incision, the chest wall incision suture.
The results 2
206 cases were successfully completed surgery, surgery time 18 ~ 32min, the average (26 ± 7) min. Blood loss 10 ~ 25 ml, an average of 15 ± 6 ml. There was no mortality, no device off, no blood transfusion, 5h after extubation; patients can get out of bed on the same day, after review 3d color Doppler, no residual shunt. Postoperative hospital stay (4 ± 2) d. 186 cases were followed up for 6 months, 57 cases were followed up 3 to 4.5 years, the patient recovered well, color Doppler showed no residual shunt, all patients with normal cardiac function.
3 to discuss percutaneous intervention in the treatment of atrial septal defect play an important role in [2,3], but its operation in the high-dose X-ray irradiation, to be closed for the central defect of form, but not too defect, it is quite Patient because the conditions and restrictions on the use of conventional surgical treatment, but major trauma. Hospital in April 2000 the first to explore the small incision in the chest VATS window into the memory nickel titanium alloy atrial septal defect umbrella success for the treatment of atrial septal defect closure and opened up a new way [2]. In May 2000 in our hospital do not use video-assisted, only next to the sternum on the right side of No. 4 intercostal incision made 2 ~ 3 cm, to complete the operation. This method is a short path, simple, accurate and achieve the desired characteristics of the location, making the basic push sheath can be vertical at the mouth defect, in the process of closure of atrial septal defect do not ask for much, no major structural defect (as inferior vena cava, Inferior vena cava, mitral valve and coronary sinus) Office missing the edge of the size of the requirements of low, wide indication, but also to the superior vena cava, the inferior vena cava, mitral valve, and other small effects. Off-pump through a small chest incision closure of atrial septal defect surgery, a simple procedure, a small degree of difficulty, trauma, the patient recovered quickly, the patients can get out of bed the day of surgery, postoperative (4 ± 2) d discharged from hospital. The surgery in the operating room, X-ray radiation without damage, higher security; broad indication is the treatment of atrial septal defect diameter> 30 mm of large septal defects, some of the edge of the absence of atrial septal defect, atrial septal-prone Atrial septal defect and bulging tumor surgery ideal way. 99 cases of this group in the use of percutaneous catheter occlusion after the failure by the use of thoracic surgery successful closure. After thoracic surgery septal defect closure room with its beauty, practical, safe, reliable indication of the broad features of septal defect in the treatment room has its advantages.

1. Thomson JD, AburawiE.H, Watterson KG, et al. Surgical and transcatheter (Amplatzer) closure of atrial septal defects: