Ultrasonic diagnosis and clinical management strategies for abnormal atrial septal structure in aircrews

LI Huijuan; LIU Shuping; SUN Yahui; GONG Xiaojun; ZHAO Guozheng; LI Li

doi:10.3969/j.issn.2097-1753.2025.05.010

Abstract：Objective To retrospectively analyze the ultrasound diagnosis process,clinical treatment plan,and follow-up observation results of individuals with abnormal atrial septal structure in aircrews,and to summarize theaeromedical certification conclusions.Methods A retrospective analysis was conducted on 33 male aircrews who underwent contrast transthoracic echocardiography(cTTE)and transesophageal echocardiography(TEE)in the department of ultrasound diagnosis at the Air Force Medical Center between February 2023 and August 2024.The corresponding ultrasound examination protocols and clinical management strategies tailored to different types of atrial septal abnormalities and grades of right-to-left shunt(RLS)were analyzed.Their aeromedical certification conclusions and comprehensive evaluation results were also discussed.Results The 33 cases of abnormal atrial septal structure included 2 cases of atrial septal defect(ASD),23 cases of simple patent foramen ovale(PFO),5 cases of complex PFO,2 cases of atrial septal aneurysm(ASA),and 1 case of thin atrial septum.The distribution of RLS grades on cTTE differed significantly between the resting state(Grade 0:15 cases,Grade Ⅰ:2 cases,Grade Ⅱ:10 cases,Grade Ⅲ:6 cases)and the valsalva maneuver state(Grade Ⅰ:9 cases,Grade Ⅱ:6 cases,Grade Ⅲ:18 cases)(Z=-4.756,P＜0.001).Among the 17 follow-up observers with small to moderate shunts,1 case who refused PFO closure was assessed as original aircraft qualified-unsuitable for modification,1 case who choos was assessed as atrial septal defect,and 15 cases were comprehensively evaluated as flying qualified as the shunt was deemed to have no significant clinical significance.16 cases with large shunts underwent interventional closure.The distribution of RLS grades on cTTE differed significantly immediately post-procedure(Grade 0:8 cases,Grade Ⅰ:7 cases,Grade Ⅱ:1 case),at 6 months(Grade 0:10 cases,Grade Ⅰ:6 cases),and at 12 months(Grade 0:16 cases)(Friedman x2=13.040,P=0.001).No recurrent shunt was observed in any flyinig personnel following successful closure.Based on review results,14 cases were certified as flying qualified,and 2 cases were assessed as flying not qualified.Conclusions A stepwise ultrasound examination protocol,stratified assessment of shunt severity,and close follow-up are crucial for aircrews with abnormal atrial septal structure.Corresponding safe and effective clinical management strategies should be implemented.