Objective: To compare the efficacy of percutaneous atrial septal defect (ASD) closure guided by transesophageal echocardiography (TEE) or guided by fluoroscopy in pediatric patients.
Methods: Medical records of patients who underwent percutaneous ASD closure in the Children's Hospital, Zhejiang University School of Medicine from January 2017 to March 2018 were reviewed. There were 120 patients whose procedures were guided by TEE (TEE group), and 125 patients who had their procedures guided by fluoroscopy (fluoroscopy group). The performance of surgery, efficacy and postoperative complications were compared between two groups.
Results: Percutaneous ASD closure was successful in all patients. The operation time was shorter in the TEE group than that in fluoroscopy group[(20±14) min vs. (29±11) min, t=-7.939, P<0.05]. The size of the defect was larger in the TEE group than that of fluoroscopy group[(11±4) mm vs. (9±4) mm, t=2.512, P<0.05], but there was no significant difference in the sizes of occluder and occluder sheath between two groups (all P>0.05). No residual shunt, occluder shedding or displacement, severe arrhythmia or pericardial effusion were observed in either group. The incidence rates of fever, cough and diarrhea were not statistically different between two groups (all P>0.05).
Conclusions: There was no significant difference in the outcome of percutaneous ASD closure guided by TEE or by fluoroscopy, but the procedure guided by TEE may reduce the operation time and can evaluate the size of ASD more accurately without involving radiation exposure, contrast agents use and large digital subtraction equipment.
目的: 比较单纯食管超声心动图（TEE）引导与X射线引导经皮房间隔缺损（ASD）封堵术治疗ASD患儿的疗效差异。
方法: 回顾性分析2017年1月至2018年3月浙江大学医学院附属儿童医院行单纯TEE引导经皮ASD封堵术患儿（TEE组，120例）和行X射线引导经皮ASD封堵术患儿（X射线组，125例）的资料。比较两组的手术实施情况、术后疗效和术后并发症发生情况等资料。
结果: TEE组和X射线组均顺利完成ASD封堵术。TEE组手术时间为（20±14）min，X射线组为（29±11）min，差异有统计学意义（ t=-7.939， P < 0.05）；TEE组ASD直径为（11±4）mm，大于X射线组[（9±4）mm， t=2.512， P < 0.05]，但两组在术中使用的封堵器直径和外鞘直径差异无统计学意义（均 P>0.05）。两组患儿术后均无残余分流、封堵器脱落或移位，未发生严重心律失常、心包积液。术后发热、咳嗽、腹泻的发生率两组间差异无统计学意义（均 P>0.05）。
结论: 单纯TEE引导经皮ASD封堵术与X射线引导经皮ASD封堵术疗效相近，但前者避免了射线辐射、手术时间短、对ASD的直径评估更精确，且无需使用大型数字减影设备，适宜推广和普及。