Objective To compare surgical results between real-time three dimensional echocardiography（RT-3DE） guided closure of atrial septal defect （ASD） through a right minithoracotomy and traditional surgical repair under cardiopulmonary bypass （CPB）. Methods Sixty-four patients with secundum ASD received surgical repair in the First People’s Hospital of Honghe Autonomous Prefecture from April 2009 to April 2012. According to different surgical approach, all the patients were divided into group A and B. In group A, 35 patients underwent traditional ASD repair under CPB including 20males and 15 females with their age of 12-56 （16.4±4.0） years. In group B, 29 patients received real-time RT-3DE guidedASD closure through a right minithoracotomy without CPB, including 20 males and 15 females with their age of 15-50 （18.5±0.2） years. Operation time，postoperative mechanical ventilation time，hospital stay，chest drainage，mortality，morbidity and follow-up outcomes were compared between the 2 groups. Results Operation time （110.47±35.90 minutesvs. 159.32±20.60 minutes），postoperative mechanical ventilation time （10.40±22.30 hours vs. 16.40±12.20 hours），chestdrainage （106.71±85.20 ml vs. 146.70±75.63 ml）and postoperative hospital stay （4.0±1.0 days vs. 7.0±1.0 days）ofgroup B were significantly shorter or less than those of group A. In group A, 1 patient died postoperatively and 7 patientshad postoperative complications. In group B, there was no in-hospital mortality and 3 patients had postoperative complications.Postoperative morbidity of group A was significantly higher than that of group B （20.0% vs. 10.3%，P＜0.05） . ConclusionFor ASD patients with definite surgical indications，RT-3DE guided ASD closure through a right minithoracotomy has more advantages over traditional surgical repair under CBP.
Citation：
PENG Xuguang,QIAN Mengjiao,XU Jinming,LI Jun,WANG Jing.. Real-time Three Dimensional Echocardiography Guided Closure of Atrial Septal Defect through a RightMinithoracotomy in Comparison with Traditional Surgical Repair under Cardiopulmonary Bypass. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 637-641. doi: 10.7507/1007-4848.20130202
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Bellinger DC， Wypij D， Kuban KC， et al. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation， 1999， 100 （5）：526-532.
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刘迎龙. 右外侧小切口剖胸在先天性心脏病手术中的应用. 中国微创外科杂志， 2004， 4 （5）：358-359.
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Downing SW， Herzog WA Jr， McLaughlin JS， et al. Beating-heart mitral valve surgery：preliminary model and methodology. J Thorac Cardiovasc Surg， 2002， 123 （6）：1141-1146.
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Kim NK， Park SJ， Shin JI， et al. Eight-French intracardiac echocardiography - safe and effective guidance for transcatheter closure in atrial septal defects. Circ J， 2012， 76 （9）：2119-2123.
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赵铁夫， 王盛宇， 张总刚， 等. 非体外循环房间隔缺损封堵术切口选择的探讨. 北京医学， 2008， 30 （2）：78-80.
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康云帆， 俞世强， 蔡振杰， 等. 微创非体外循环房间隔缺损封堵术的临床应用. 第四军医大学学报， 2003， 24 （3）：201.
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钱永祥， 张晓膺， 狄冬梅， 等. 经右胸壁微创封堵术治疗房间隔缺损21例. 江苏医药， 2012， 38 （3）：349-350.
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Warinsirikul W， Sangchote S， Mokarapong P， et al. Closure of atrial septal defects without cardiopulmonary bypass：the sandwich operation. J Thorac Cardiovasc Surg， 2001， 121 （6）：1122-1129.
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Mishaly D， Ghosh P， Preisman S， et al. Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach. Ann Thorac Surg， 2008， 85 （3）：831-835.
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Naqvi TZ. Recent advances in echocardiography. Cardiovasc Ther， 2004， 2 （1）：89-96.
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Suematsu Y， Marx GR， Triedman JK， et al. Three-dimensional echo-guided beating-heart surgery without cardiopulmonary bypass：feasibility study. J Thorac Cardiovasc Surg， 2004， 128 （4）：579-587.
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孙勇， 舒涛， 廖崇先， 等. 微创封堵术治疗房间隔缺损. 中华医学会第七次全国胸心血管外科学术会议暨2007中华医学会胸心血管外科青年医师论坛论文集心血管外科分册， 2007， 11 （1）：113.
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Cannon JW， Stoll JA， Salgo IS， et al. Real-time three-dimensional ultrasound for guiding surgical tasks. Computer Aided Surg， 2003， 8 （2）：82-90.
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Laussen PC， Bichell DP， McGowan FX， et al. Postoperative recovery in children after minimum versus full-length sternotomy. Ann Thorac Surg， 2000， 69 （2）：591-596.
|
| 17. |
Cooke JC， Gelman JS， Harper RW. Cobrahead malformation of the Amplatzer septal occluder device：an avoidable compilation of percutaneous ASD closure. Catheter Cardiovasc Interv， 2001， 52 （1）：83-85.
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| 18. |
Berdat PA， Chatterjee T， Pfammatter JP， et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg， 2000， 120 （6）：1034-1039.
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| 19. |
王黎明.房间隔缺损介入治疗1000例临床分析. 临床心血管病杂志， 2009， 25 （7）：552-553.
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童健， 阎玉生， 钱希明， 等. 微创伤非体外循环房间隔缺损封堵术5 例. 第一军医大学学报， 2003， 23 （11）：1231-1232.
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- 1. Zeitlhofer J， Asenbaum S， Spiss C， et al. Central nervous system function after cardiopulmonary bypass. Eur Heart J， 1993， 14 （7）：885-890.
- 2. Bellinger DC， Wypij D， Kuban KC， et al. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation， 1999， 100 （5）：526-532.
- 3. 刘迎龙. 右外侧小切口剖胸在先天性心脏病手术中的应用. 中国微创外科杂志， 2004， 4 （5）：358-359.
- 4. Sogawa M， Moro H， Tsuchida M， et al. Development of an endocardioscope for repair of an atrial septal defect in the beating heart. ASAIO J， 1999， 45 （1）：90-93.
- 5. Downing SW， Herzog WA Jr， McLaughlin JS， et al. Beating-heart mitral valve surgery：preliminary model and methodology. J Thorac Cardiovasc Surg， 2002， 123 （6）：1141-1146.
- 6. Kim NK， Park SJ， Shin JI， et al. Eight-French intracardiac echocardiography - safe and effective guidance for transcatheter closure in atrial septal defects. Circ J， 2012， 76 （9）：2119-2123.
- 7. 赵铁夫， 王盛宇， 张总刚， 等. 非体外循环房间隔缺损封堵术切口选择的探讨. 北京医学， 2008， 30 （2）：78-80.
- 8. 康云帆， 俞世强， 蔡振杰， 等. 微创非体外循环房间隔缺损封堵术的临床应用. 第四军医大学学报， 2003， 24 （3）：201.
- 9. 钱永祥， 张晓膺， 狄冬梅， 等. 经右胸壁微创封堵术治疗房间隔缺损21例. 江苏医药， 2012， 38 （3）：349-350.
- 10. Warinsirikul W， Sangchote S， Mokarapong P， et al. Closure of atrial septal defects without cardiopulmonary bypass：the sandwich operation. J Thorac Cardiovasc Surg， 2001， 121 （6）：1122-1129.
- 11. Mishaly D， Ghosh P， Preisman S， et al. Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach. Ann Thorac Surg， 2008， 85 （3）：831-835.
- 12. Naqvi TZ. Recent advances in echocardiography. Cardiovasc Ther， 2004， 2 （1）：89-96.
- 13. Suematsu Y， Marx GR， Triedman JK， et al. Three-dimensional echo-guided beating-heart surgery without cardiopulmonary bypass：feasibility study. J Thorac Cardiovasc Surg， 2004， 128 （4）：579-587.
- 14. 孙勇， 舒涛， 廖崇先， 等. 微创封堵术治疗房间隔缺损. 中华医学会第七次全国胸心血管外科学术会议暨2007中华医学会胸心血管外科青年医师论坛论文集心血管外科分册， 2007， 11 （1）：113.
- 15. Cannon JW， Stoll JA， Salgo IS， et al. Real-time three-dimensional ultrasound for guiding surgical tasks. Computer Aided Surg， 2003， 8 （2）：82-90.
- 16. Laussen PC， Bichell DP， McGowan FX， et al. Postoperative recovery in children after minimum versus full-length sternotomy. Ann Thorac Surg， 2000， 69 （2）：591-596.
- 17. Cooke JC， Gelman JS， Harper RW. Cobrahead malformation of the Amplatzer septal occluder device：an avoidable compilation of percutaneous ASD closure. Catheter Cardiovasc Interv， 2001， 52 （1）：83-85.
- 18. Berdat PA， Chatterjee T， Pfammatter JP， et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg， 2000， 120 （6）：1034-1039.
- 19. 王黎明.房间隔缺损介入治疗1000例临床分析. 临床心血管病杂志， 2009， 25 （7）：552-553.
- 20. 童健， 阎玉生， 钱希明， 等. 微创伤非体外循环房间隔缺损封堵术5 例. 第一军医大学学报， 2003， 23 （11）：1231-1232.
