ObjectiveTo summarize clinical outcomes of atrial septal defect (ASD)occlusion for patients with ASD and tricuspid regurgitation (TR). MethodsBetween July 2006 and January 2012, 98 patients with ASD and TR under-went ASD occlusion in Xinhua Hospital, Shanghai Jiaotong University School of Medicine. There were 36 male and 62 female patients with their age aging from 2 months to 80 years. All ASD were secundum ASD with their diameter of 3-23 mm. There were 60 patients with mild TR, 28 patients with moderate TR, and 10 patients with severe TR. All the patients received ASD closure without specific management for TR, including 51 patients under digital subtraction angiography (DSA), 46 patients via a minithoracotomy approach, and 1 patient guided by transthoracic echocardiography. All the patients were followed up with echocardiography to evaluate changes of TR after ASD closure. ResultsThere was no in-hospital death. ASD occlusion was not successful in 1 patient who was found to have residual ASD shunt on the third postoperative day. Another patient underwent reexploration for abnormal bleeding on the third postoperative day. All the other patients had uneventful postoperative recovery. Eighty-four patients were followed up for 1-64 (26.56±21.35)months. During follow-up, the patient who have residual ASD shunt on the third postoperative day received open chest repair 6 months after discharge. TR of 73 patients (86.90%)improved in different degrees. Preoperative severe TR in 10 patients changed into mild TR in 8 patients, moderate TR in 1 patients and still severe TR in 1 patient. Preoperative moderate TR in 26 patients changed into none TR in 6 patients, mild TR in 18 patients and still moderate TR in 2 patients. Preoperative mild TR in 48 patients changed into none TR in 40 patients and still mild TR in 8 patients. ConclusionFor patients with ASD and TR, conservative treatment strategy is recommended. Simple ASD closure can provide satisfactory clinical outcomes, and also avoid adverse complications of cardiopulmonary bypass including myocardial injury and lung injury.
ObjectiveTo investigate influence of left atrial contraction on lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. MethodsClinical data of 57 patients with lone atrial fibrillation underwent minimally invasive radiofrequency ablation in Department of Cardiothoracic Surgery, Xinhua Hospital, Medical School of Shanghai Jiaotong University from September 2010 to December 2011 were retrospectively analyzed. According to the absence of mitral A velocity, patients were divided into Group A (absence of mitral A velocity, 20 patients with their age of 56.32±17.18 years, including 5 females) and Group B (mitral A velocity exists, 37 patients with their age of 60.33±11.22 years, including 17 females). Minimally invasive radiofrequency ablation via thoracoscope were performed in all patients. Preoperative and postoperative left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and mitral A velocity, as well as clinical and follow-up data were recorded and compared. ResultsPreoperative clinical characters were not statistically different between two groups (P > 0.05). All the patients were followed up for 24.3±8.8 months (range, 12-26 months). Rate of postoperative atrial fibrillation recurrence in group A was significantly higher than that in group B (20.0% vs. 2.7%, P < 0.05). LAD and LVEF of 57 patients at 6 months after surgery were significantly higher than preoperative LAD and LVEF (P < 0.05), but there was no statistic difference between two groups (P > 0.05). ConclusionDamage of left atrial contraction was related to lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. Absence of mitral A velocity could be a crucial predictor of postoperative lone atrial fibrillation recurrence.