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Application of Transoesophageal Echocardiography in Minimally Invasive Surgical closure of Atrial or ventricular septal defects Without Cardiopulmonary Bypass
Hong Tang, Wen-juan Bai, Qi An, Ke Dian, Er-yong Zhang
 Department of Cardiology, West China Hospital of Sichuan University, Chengdu 610041, China


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Objective To evaluate the clinical value of transoesophageal echocardiography in minimally invasive techniques closure of atrial,ventricular septal defects.

Methods 34 patients with ASD and 38 patients with VSD were selected by the transthoracic echocardiography (TTE) to perform minimally invasive closure of defect. All ASD is secundum, the maximal diameter of defects from 9 to 33mm; In the VSD group, 36 with perimembranous type, 1with residual postsurgical repair of double orifice of right ventricle, 1 with multiple VSD and patent defect arteriosus, the maximal diameter of defects from 3 to12mm. Under general anesthesia, TEE study was done, to analyze anatomy, the size of the defect, the number of holes, and the spatial position within the septum, to select the device size and type, CDFI observed the shunt flow through the defect. The device was introduced and implanted under TEE monitoring, once the occluder was released, immediate ultrasonographic evaluation was made. All patients were followed by TTE within 2–7 days after the procedure.

Results 32 patients with ASD received the occlusion successfully. The last TEE study showed no displacement, residual shunt, or valve’s dysfunction were observed. 29 patients with VSD underwent the procedure successfully. TEE showed 27 had complete occlusion and 2 had a minor residual shunt, all had no displacement, or valve’s dysfunction. 4 patients with VSD received cardiopulmonary bypass(CPB) repair surgery for the badly condition because not suitable for occlusion. 2 with ASD and 5 with VSD underwent CPB operation because of occlusion failure. All the 61 patients who were underwent successful implantation received follow-up by TTE within 2–7 days after the procedure, complete occlusion in 58 patients and a trivial residual shunt in 3 with ASD, no other complication was observed in all the  patients. The ventricle diameter, the valve regurgitation, the pulmonary artery pressure were decreased after surgery.

Conclusions TEE plays a very important role in performing minimally invasive surgery, which shows that minimally invasive surgical closure of ASD,VSD is feasible, safe, and effective, further application needed to be observed in the future.