A comparative study of different minimally invasive occlusion in the treatment of atrial septal defects in infants
Bilali PAIZULA
Dina NUERLAN
YANG Long
WANG Yue-ru
Yimuran KAWULIJIANG
CHEN Ji-yao
MA Song-feng
ZHANG Guo-ming
Abstract：Objective To investigate the efficacy and indications of transcatheter closure of atrial septal defect(ASD)in infants via internal jugular vein,femoral vein and right infra-axillary incision respectively under the guidance of echocardiography.Methods The clinical data of 131 infants(0-3 years old)with simple ASD who received transcathter closure treatment in the Pediatric Cardiothoracic Surgery Department of the First Affiliated Hospital of Xinjiang Medical University from January 2022 to December 2023 were analyzed retrospectively.According to different surgical methods,the patients were divided into the internal jugular vein group(n=39),the femoral vein group(n=44),and the right infra-axillary incision group(n=48).The ages,weights,ASD diameters,operation times,intraoperative blood loss volumes,postoperative hospitalization times,hospitalization costs,incidence of postoperative residual shunt and incidence of postoperative complications as well as postoperative FLACC pain scores at 1 h,12 h and 24 h were compared among the three groups.Results The age and weight of the femoral vein group were older and heavier than the internal jugular vein group and the right infra-axillary incision group(P＜0.05),the diameter of the ASD in the right infra-axillary incision group was smaller than the internal jugularvein group and the femoral vein group[6.5(5.0,9.0)mm vs.8.0(7.0,10.0)mm vs.8.0(6.0,11.0)mm](P＜0.05).Surgical time[100.00(65.00,103.75)vs.60.00(45.00,70.00)vs.42.50(35.00,60.00)min],intraoperative blood loss volume[7(5,9)vs.5(3,5)vs.5(3,5)ml],postoperative hospitalization time[8.0(6.0,10.0)days vs.4.0(3.0,5.0)days vs.3.5(3.0,5.0)days]and hospitalization cost[39304(37458,44399)yuan vs.24172(23585,25891)yuan vs.22309(21408,29693)yuan]in the right infra-axillary incision group were longer and more than the internal jugular vein group and the femoral vein group(P＜0.05).There was no significant difference in the incidence of postoperative residual shunt or complications between the three groups(P＞0.05).The FLACC scores of the right infra-axillary group at different times were higher than those of the internal jugular vein group and the femoral vein group(P＜0.05).The FLACC scores of the femoral vein group at 12 h and 24 h were higher than the internal jugular vein group(P＜0.05).Conclusion Echocardiography-guided transcatheter closure via the internal jugular vein,the femoral vein and the right infra-axillary incision has the same efficacy in the treatment of ASD in infants.Transcatheter closure via the internal jugular vein is more suitable for the younger,low-weight infants and provides better postoperative comfort.Closure via the right infra-axillary incision has a wide range of indications,but it is costly and associated with significant postoperative pain.Closure via the femoral vein is in the middle of the two and is suitable for the older,heavier infants.
Keywords：Atrial septal defectMinimally invasive treatmentOccluderPain scoreInfant
Publication Date：2025-04-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 342-347 )