Optimization of Echo Views for Percutaneous Device Closure of Pediatric Atrial Septal Defect through the Femoral Vein Guided by Transthoracic Echocardiography without Radiation.

Zankai Ye,Yaobin Zhu,Pei Li,Yan Sun,Zhiqiang Li,Hanlu Yi,Ning Ma,Hongju Zhang

doi:10.1155/2020/8242790

Abstract

Objectives This study aimed to explore the selection of views for transthoracic echocardiography-guided transfemoral puncture for the device closure of pediatric atrial septal defect (ASD) without radiation. Methods Sixty children (29 males and 31 females) were diagnosed with a central ASD, normal heart function, and no other intracardiac deformity. All procedures were performed in a surgical operating room (without radiological equipment) under basic anesthesia; the femoral vein pathway and guidance by only transthoracic echocardiography were used to complete the device closure of the ASD. The subcostal acoustic window and parasternal aorta short-axis views were used to guide the extra stiff wire and catheter into the left atrium. All procedures were performed under the subcostal biatrial section. The sheath entered the left atrium, and the apical four-chamber view was used to monitor the delivery and release of the occluder. Results Successful closure of the ASD was achieved in all cases. The operating time from the end of the puncture to the release of the occluder was 10.36 ± 3.57 minutes. No other incisions were needed in 60 cases. No occluders were removed, and no residual shunt or pericardial effusions were detected after the procedures, during the non-ICU stay time. The average hospital stay was 2.19 ± 0.58 days. Conclusion The accurate selection of transthoracic echocardiographic views can better ensure the safety and effectiveness of ASD closure through the femoral vein without radiation in children.

Highlights

Atrial septal defect (ASD) is a common congenital heart disease
Us far, few articles focused on the choices and sequence of views during the procedure. is paper aims to study the accurate selection of intraoperative-related echocardiographic views to explore and achieve the standardization of zero-radiation-guided percutaneous closure of ASD
We completed the entire procedure under the guidance of transthoracic echocardiography (Figures 1(a)–1(c); Figures 2(a)–2(d)): (1) e subcostal view was used to guide the guidewire and catheter to search for the ASD in real time (Figure 3(a))

Summary

Introduction

Atrial septal defect (ASD) is a common congenital heart disease. Percutaneous interventional closure has become the main treatment for secondary ASD regardless of open-heart surgery and extracorporeal circulation [1, 2]. To overcome the above shortcomings and reveal the noninvasive advantages of echocardiography, we aimed to accomplish the procedure solely under the guidance of echocardiography. E safety and efficacy of percutaneous interventional closure of ASD has been widely recognized [3–5] but has been guided by X-rays. Identifying approaches relying solely on transthoracic echocardiography to ensure the safe completion of percutaneous occlusion of ASD is important. Us far, few articles focused on the choices and sequence of views during the procedure. Us far, few articles focused on the choices and sequence of views during the procedure. is paper aims to study the accurate selection of intraoperative-related echocardiographic views to explore and achieve the standardization of zero-radiation-guided percutaneous closure of ASD.

Objectives

Methods

Results

Conclusion