摘要
Objectives To improve experience of procedure and success rate of interventional treatment of atrial septal defect （ASD） in children, applying the technique of controlling release of devices in the pulmonary vein （controlling two disc of device opening for subsequence） in children cases with ASD who can not be occluded by regularly interventional treatment. Methods Since 2000 year 182 child cases （male 70 and 112 female） underwent the procedure of controlling release of devices in the pulmonary vein. The patients＇ age was from 2 to 14 years old （average 3.77±1.55）. The body weight was from 9 to 48 Kg （average 21.53±10.63）. When the devices were placed on the right position with difficulty and failure in some cases with short and soft rims of the defect and large defect and the angle between the device and the interval atrial septal （IAS）, It could be helpful to put the device into the left upper pulmonary vein, and to make right atrium （proximal） disc opened before the left atrium （distal） disc naturally fall down. At the end the double disc of the device clamped and stood up at the right position of the IAS. After closure of ASD, patients were followed up regularly by echocardiography, X-ray and ECG in the 1,3,6,12 month and 3,5 years. Results The successful rate of device implantation in the improving group （98.4%） was obviously higher than that in the regularly group （68%）. The techniques improved in this group with the smaller age, the lighter weight, the larger defect and the larger device comparing with the regularly group. The velocity of the pulmonary vein before occlusion procedure was （0.54±0.15）m/s; after procedure was （0.56±0.16）m/s, P 〉 0.05,there were no significant difference. All cases couldn＇t found pulmonary congestion by follow up. Conclusions The method of controlling release of device in the pulmonary vein has been used more than 5 years in the occlusion of ASD with double disc device. It is feasible and safety. The aim of the improvement is for overcoming the problem with larger ASD and the rim deficiency in the interventional procedure in children with ASD. In summary： 1. The performance of the procedure must be careful; 2. To avoid complication when put the sheath into the pulmonary vein; 3. To avoid to put the left disc into pulmonary vein too long and pull the device too much; 4. When the procedure have to operate repeatedly, the device can not be released before the position satisfactory. The improvement of the technique is needed to carry on long-term follow-up in the clinical trials.
Objectives To improve experience of procedure and success rate of interventional treatment of atrial septal defect （ASD） in children, applying the technique of controlling release of devices in the pulmonary vein （controlling two disc of device opening for subsequence） in children cases with ASD who can not be occluded by regularly interventional treatment. Methods Since 2000 year 182 child cases （male 70 and 112 female） underwent the procedure of controlling release of devices in the pulmonary vein. The patients＇ age was from 2 to 14 years old （average 3.77±1.55）. The body weight was from 9 to 48 Kg （average 21.53±10.63）. When the devices were placed on the right position with difficulty and failure in some cases with short and soft rims of the defect and large defect and the angle between the device and the interval atrial septal （IAS）, It could be helpful to put the device into the left upper pulmonary vein, and to make right atrium （proximal） disc opened before the left atrium （distal） disc naturally fall down. At the end the double disc of the device clamped and stood up at the right position of the IAS. After closure of ASD, patients were followed up regularly by echocardiography, X-ray and ECG in the 1,3,6,12 month and 3,5 years. Results The successful rate of device implantation in the improving group （98.4%） was obviously higher than that in the regularly group （68%）. The techniques improved in this group with the smaller age, the lighter weight, the larger defect and the larger device comparing with the regularly group. The velocity of the pulmonary vein before occlusion procedure was （0.54±0.15）m/s; after procedure was （0.56±0.16）m/s, P 〉 0.05,there were no significant difference. All cases couldn＇t found pulmonary congestion by follow up. Conclusions The method of controlling release of device in the pulmonary vein has been used more than 5 years in the occlusion of ASD with double disc device. It is feasible and safety. The aim of the improvement is for overcoming the problem with larger ASD and the rim deficiency in the interventional procedure in children with ASD. In summary： 1. The performance of the procedure must be careful; 2. To avoid complication when put the sheath into the pulmonary vein; 3. To avoid to put the left disc into pulmonary vein too long and pull the device too much; 4. When the procedure have to operate repeatedly, the device can not be released before the position satisfactory. The improvement of the technique is needed to carry on long-term follow-up in the clinical trials.
