Abstract
ObjectiveTo investigate the efficacy and safety of simultaneous percutaneous interventional treatment of atrial septal defects (ASDs) and pulmonary valve stenosis (PS) in children under the guidance of transoesophageal echocardiography (TEE) alone.MethodsEleven children with ASD combined with PS who were treated at our hospital between March 2015 and March 2019 were recruited, including 4 males and 7 females. Preoperative transthoracic echocardiography showed that all patients had type II ASDs of the foramen ovale subtype, with a maximum diameter of 12.9 ± 2.7 mm (9.0–18.0 mm). The guiding principle of septal occluder selection is that the diameter of the occluder should be 2–4 mm larger than the maximum diameter of the ASD. The pressure gradient across the pulmonary valve in patients with PS was 54.7 ± 5.8 mmHg (47.0–64.0 mmHg), and a balloon with a diameter 1.2–1.4 times the diameter of the pulmonary valve annulus was used for dilatation. Effective dilatation was repeated 2–3 times. All children underwent ASD occlusion and PS balloon dilatation through the femoral vein under TEE guidance without radiation or contrast agents. The patients underwent PS balloon dilatation first, followed by ASD occlusion. The treatment effect was evaluated by TEE immediately after the procedure, and the patients were followed up regularly.ResultsAll patients underwent successful simultaneous ASD occlusion and PS balloon dilatation through the femoral vein under the guidance of TEE alone. The pressure gradient across the pulmonary valve immediately after the procedure was 21.3 ± 1.8 mmHg (19.0–25.0 mmHg) (P < 0.01). No shunt was detected at the atrial septum level. The patients were followed for 3.0 ± 1.4 years (1.0–5.0 years) after the procedure. The atrial septal occluders were in the normal position in all of the patients, and there was no arrhythmia, hemolysis, or residual shunting. The pressure gradient across the pulmonary valve at 1 month after the procedure was 18.5 ± 3.3 mmHg (P < 0.01).ConclusionSimultaneous percutaneous interventional treatment of ASD and PS in children under the guidance of TEE alone is not only safe and effective but also prevents trauma caused by extracorporeal circulation and surgical incision and damage caused by X-ray and contrast agents. The surgical sequence included first performing PS balloon dilatation, followed by ASD occlusion.
Highlights
IntroductionThe main treatments for patients with atrial septal defects (ASDs) combined with pulmonary valve stenosis (PS) are conventional surgery and vascular intervention [1]
Congenital heart disease is commonly complicated with malformations
The exclusion criteria were as follows: [1] patients with ostium primum atrial septal defects (ASDs) or sinus venosus ASD, endocarditis, or hemorrhagic disorder; [2] patients with infundibular pulmonary stenosis, pulmonary valve stenosis (PS) accompanied by congenital subvalvular pulmonary stenosis, PS accompanied by supravalvular pulmonary stenosis, severe dysplastic PS, or concurrent diseases that required surgical treatment; and [3] diseases that were contraindications for transoesophageal echocardiography (TEE), such as esophageal stenosis and tonsillitis
Summary
The main treatments for patients with atrial septal defects (ASDs) combined with pulmonary valve stenosis (PS) are conventional surgery and vascular intervention [1]. Patients who have undergone conventional surgery have many complications and recover slowly [2]. Children undergoing vascular intervention are exposed to radiation and contrast agents. The use of radiation must be limited because it may cause irreversible damage [3,4,5]. The emergence of transoesophageal echocardiography (TEE) and its application in interventional treatments can prevent damage from radiation and contrast agents and allow monitoring of the operation and valve opening and closing activities in real time. This study explores the safety and efficacy of percutaneous interventional treatment for children with ASD and PS under the guidance of TEE alone
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