Analysis of therapeutic effect of percutaneous device closure to atrial septal defect via right internal jugular vein under the guidance of transesophageal echocardiography in children

Abstract

Objective To evaluate the effect of percutaneous device closure guided by transesophageal echocardiography (TEE) on atrial septal defect(ASD) via right internal jugular vein(RIJV) in children. Methods A total of 8 cases with secundum ASD were recruited as candidates to receive percutaneous device closure via RIJV between July 22 and November 5, 2015 in Heart Center, Dalian Children′s Hospital.In this group, 5 boys and 3 girls who were 5 months to 10 years old were included.The youngest patient was a 30 weeks premature infant of 5 months old, with 3-month correction gestational age.All patients were clearly diagnosed as ASD by transthoracic echocardiography(TTE) before operation.Five patients had single central type ASD which were 5-8 mm in diameter, and 3 patients had multiple(1 biforate and 2 cribriform) ASD which were 10-12 mm in shunt range.New type Fustar curve adjustable sheath was delivered after RIJV accessed.By passing through the ASD by adjusting the depth and bending of the tips of sheath, then the device was delivered and released to close the ASD.The procedures were always guided and monitored by TEE.After the devices were released, the position of device, residual shunt, and the effect of valves were assessed by TEE or TTE. Results All patients were tested with TEE and TTE after procedure, devices were stable and well shaped, and the defects were closured well without any residual shunt.All the patients were followed up more than 6 months.No hydropericardium, thrombogenesis, tachyarrhythmia, complete atrioventricular block or other complications were found. Conclusions To close ASD with new type curve adjustable sheaths via RIJV may have wide indications, short operation path, well curative effect, minimal invasion and fast recovery in pediatrics, especially fit for the small age children with a big ASD who are difficult to treat via femoral vein. Key words: Atrial septal defect; Intervention therapy; Echocardiography, transesophageal