Objective To analyze the influencing factors and outcomes of atrial septal defect (ASD) and ventricular septal defect (VSD) occlusion guided by echocardiography. Methods We retrospectively analyzed the clinical data of 188 patients receiving transthoracic and percutaneous transcatheter closure of ASD and VSD from July 2009 to July 2017 in our department, including 74 males and 114 females, aged 13.48±13.53 years ranging from 1 to 65 years. Results Fifty-three ASD patients accepted transthoracic closure surgery, of whom 4 patients were difficult to close and 6 patients failed to close; 24 patients underwent percutaneous transcatheter ASD occlusion surgery, of whom 3 were difficult to close and 1 failed in occlusion; 108 VSD patients implemented transthoracic closure surgery, of whom 10 patients were difficult to close and 5 patients failed in closure; 9 VSD patients underwent percutaneous transcatheter closure, of whom 5 failed and then was converted to transthoracic closure. Our study showed that too large or too small aperture was the independent risk factor. Two kinds of closure surgery had their own advantages and disadvantages. The special type of VSD was the influencing factor of transthoracic closure. Conclusion When the ASD diameter≥25 mm, transthoracic closure is the best choice to avoid the use of large occluder. When the ASD diameter<25 mm, percutaneous closure surgery is the best choice. When the ASD diameter≥35 mm, it is best to give up the closure operation. Technical improvements can significantly raise the closure success rate of the subarterial VSD. For the entry diameter>10 mm and membranous aneurysm with multi-break, occlusion surgery should be avoided in VSD.
Objective To observe early and intermediate-term clinical outcomes of tricuspid valvuloplasty withannuloplasty ring for the treatment of secondary tricuspid regurgitation （TR） of patients with rheumatic heart disease. MethodsFrom December 2009 to September 2011, 41 patients with rheumatic heart disease underwent left-side heart valve replacementand concomitant tricuspid valvuloplasty with annuloplasty ring in Sichuan Jianyang People’s Hospital. There were 12 males and 29 females with their mean age of 49 （21-67） years. Preoperatively, there were 38 patients with atrial fibrillation, 13 patients with left atrial thrombus; 2 patients with trivial TR, 5 patients with mild TR, 11 patients with moderate TR, and 23 patients with severe TR. Twenty-eight patients received mitral valve replacement and 13 patients received mitral and aortic valve replacement. All the patients were followed up every 3 months at the outpatient department, and received color Doppler echocardiography examination to observe TR degree at the 6th postoperative month. Results Postoperative heart function improved by 2-3 class in all the patients. There were 39 patients with New York Heart Association (NYHA) classⅠorⅡ postoperatively, and postoperative heart function was significantly better than preoperative heart function（P＜0.05）. All the patients were followed up for 6-27 months, and there was no death during follow-up. Color Doppler echocardiography at the 6th postoperative month showed that TR degrees were significantly decreased than preoperative TR degrees. There were 39 patients with trivial or mild TR during follow-up, which was significantly different with preoperativeTR degree （P＜0.05）. Right ventricle dimension decreased from preoperative 20 mm to 17 mm during follow-up, which were statistically different （P＜0.05）. Conclusion Early and intermediate-term clinical outcomes of tricuspid valvuloplasty with annuloplasty ring for the treatment of TR are satisfactory, while further evaluation for its long-term outcome is needed.
ObjectiveTo evaluate the efficacy and safety of cardiac surgery concomitant with bipolar radiofrequency ablation(BRFA) for the patients with heart disease and atrial fibrillation(AF). MethodsFrom April 2008 to September 2014, clinical data of 167 patients(43 males, 124 females) of organic-heart-disease patients combined with atrial fibrillation were analyzed retrospectively in our hospital. Within 167 patients, 102 patients underwent bipolar radiofrequency ablation without aortic cross-clamping were as a trial group and the other 65 patients underwent cardiac surgery and bipolar radiofrequency ablation with aortic cross-clamping were as a control group. And there were no significant difference in the age and gender between the two groups. ResultsThe time of radiofrequency ablation was 23.1±5.0 minutes in all the patients and there was no significant difference between the two groups(P=0.279). The extracorporeal circulation time was 156.6±56.4 minutes and the aortic cross-clamping time was 82.1±42.6 minutes. There was a significant difference between two groups in extracorporeal circulation time and aortic cross-clamping time. One patient underwent bipolar radiofrequency ablation with aortic cross-clamping died of severe pulmonary infection and multiple organ dysfunction syndrome(MODS) in one month after the surgery. The duration of follow-up was 1-77(35.3±3.5) months. The sinus rhyme conversion rate was estimated by electrocardiogram(ECG) in 1 month, 3 months, 6 months, 12 months, 36 months, 60 months after operation. The sinus rhyme conversion rates were 85.3%(133/156), 83.4%(126/151), 82.7%(115/139), 77.0%(94/122), 75.9%(41/54), and 72.0%(18/25). There was no significant difference during the follow-up in all of the sinus rhyme conversion rate. During the fellow-up, 2 patients died. One died after 1 month and another died after 6 months after their hospital-discharges. ConclusionThe efficacy and safety of cardiac surgery concomitant with bipolar radiofrequency ablation is satisfied. It can reduce the time of myocardial ischemia in bipolar radiofrequency ablation without aortic cross-clamping. It is beneficial to critical patients.